Prevalence of Dysphonia and Dysphagia Among Adults in the United States in 2012 and 2022

PURPOSE

The purpose of this study was to compare the prevalence of dysphonia and dysphagia among adults in the United States between 2012 and 2022.

METHOD

A retrospective and cross-sectional design with national surveys was used. The 2012 and 2022 National Health Interview Surveys were utilized to estimate the number of adults reporting dysphonia and dysphagia in the past 12 months. Multivariate logistic regression models were used to examine associations between the survey year (2022 vs. 2012) and the prevalence rate of dysphonia and dysphagia while accounting for demographics and clinical characteristics.

RESULTS

The population-estimated mean age was 46.63 years in 2012, which increased to 48.12 years in 2022. In 2012, adults reporting dysphonia and dysphagia were 17.89 million (7.62%) and 9.44 million (4.02%), respectively. In 2022, these estimates increased to 29.92 million adults (11.71%) and 15.10 million adults (5.91%), respectively. Adults in 2022 had significantly higher odds for reporting dysphonia (odds ratio [OR] = 1.602, 95% confidence intervals [CIs] [1.486, 1.726], p < .0001) and dysphagia (OR = 1.461, 95% CI [1.328, 1.606], p < .0001) in the past 12 months compared to adults in 2012.

CONCLUSIONS

The population-estimates indicated that in 2022, dysphonia affected one in 8.5 adults and dysphagia affected one in 17 adults. The increase in prevalence of these disorders should serve as a call-to-action to improve access to care and research for voice and swallowing disorders.

The impact of discontinuing single-room isolation of patients with vancomycin-resistant enterococci: a quasi-experimental single-centre study in South Korea

OBJECTIVES

There is limited data on the effects of discontinuing single-room isolation while maintaining contact precautions, such as the use of gowns and gloves. In April 2021, our hospital ceased single-room isolation for patients with vancomycin-resistant enterococci (VRE) because of single-room unavailability. This study assessed the impact of this policy by examining the incidence of hospital-acquired VRE bloodstream infections (HA-VRE BSI).

METHODS

This retrospective quasi-experimental study was conducted at a tertiary-care hospital in Seoul, South Korea. Time-series analysis was used to evaluate HA-VRE BSI incidence at the hospital level and in the haematology unit before (phase 1) and after (phase 2) the policy change.

RESULTS

At the hospital level, HA-VRE BSI incidence level (VRE BSI per 1000 patient-days per month) and trend did not change significantly between phase 1 and phase 2 (coefficient -0.015, 95% confidence interval (CI): -0.053 to 0.023, P=0.45 and 0.000, 95% CI: -0.002 to 0.002, P=0.84, respectively). Similarly, HA-VRE BSI incidence level and trend in the haematology unit (-0.285, 95% CI: -0.618 to 0.048, P=0.09 and -0.018, 95% CI: -0.036 to 0.000, P = 0.054, respectively) did not change significantly across the two phases.

CONCLUSIONS

Discontinuing single-room isolation of VRE-colonized or infected patients was not associated with an increase in the incidence of VRE BSI at the hospital level or among high-risk patients in the haematology unit. Horizontal intervention for multi-drug-resistant organisms, including measures such as enhanced hand hygiene and environmental cleaning, may be more effective at preventing VRE transmission.

Item-Level Psychometrics of the Meaningful Activity Participation Assessment (MAPA) Scale

This study investigates the psychometric properties of the Meaningful Activity Participation Assessment-Meaning (MAPA-M) scale using the Rasch measurement model. For the psychometric properties of MAPA-M, principal component analysis, Rasch analysis, and differential item functioning analysis were conducted. Participants in this study were 480 older adults from the USC Well Elderly 2 study, recruited from 21 locations in the Los Angeles metropolitan area. There were eight items with DIF, but they were accepted because they assumed unidimensionality and showed good person invariance. The 25 items assuming unidimensionality of MAPA-M had values between 0.6 and 1.4 in infit and Outfit MnSq, and all ZSTD values were less than 2.0. The 25 items demonstrated a conceptual item-difficulty hierarchy. The person strata value was 2.68, which is equivalent to a reliability index value of .76. The findings indicate that the revised scale can accurately and reliably measure meaningful activities by older adults.

Efficacy of immune checkpoint inhibitors in alveolar soft-part sarcoma: results from a retrospective worldwide registry

BACKGROUND

Conventional cytotoxic drugs are not effective in alveolar soft-part sarcoma (ASPS). Immune checkpoint (programmed cell death protein 1/programmed death-ligand 1) inhibitors (ICIs) are promising drugs in ASPS. A worldwide registry explored the efficacy of ICI in ASPS.

MATERIALS AND METHODS

Data from adult patients diagnosed with ASPS and treated with ICI for advanced disease in expert sarcoma centers from Europe, Australia and North America were retrospectively collected, including demographics and data related to treatments and outcome.

RESULTS

Seventy-six ASPS patients, with a median age at diagnosis of 25 years (range 3-61 years), were registered. All patients received ICI for metastatic disease. Immunotherapy regimens consisted of monotherapy in 38 patients (50%) and combination in 38 (50%) (23 with a tyrosine kinase inhibitor). Among the 68 assessable patients, there were 3 complete responses and 34 partial responses, translating into an overall response rate of 54.4%. After a median follow-up of 36 months [95% confidence interval (CI) 32-40 months] since the start of immunotherapy, 45 (59%) patients have progressed on ICI, with a median progression-free survival (PFS) of 16.3 months (95% CI 8-25 months). Receiving ICI in first line (P = 0.042) and achieving an objective response (P = 0.043) correlated with a better PFS. Median estimated overall survival (OS) from ICI initiation has not been reached. The 12-month and 24-month OS rates were 94% and 81%, respectively.

CONCLUSIONS

This registry constitutes the largest available series of ASPS treated with ICI. Our results suggest that the ICI treatment provides long-lasting disease control and prolonged OS in patients with advanced ASPS, an ultra-rare entity with limited active therapeutic options.

Impact of carbapenem-targeted antimicrobial stewardship interventions: an interrupted time-series analysis

BACKGROUND

The development of carbapenem-resistant Gram-negative bacilli (CR-GNB) is largely favoured by indiscriminate and prolonged carbapenem use, which is a significant contributing factor.

AIM

To evaluate the impact of two carbapenem antibiotic stewardship programme interventions on both carbapenem prescriptions and the clinical isolation rates of CR-GNBs, using interrupted time-series analysis.

METHODS

A time-series analysis was performed using data for carbapenem usage from a tertiary hospital in South Korea from January 2017 to July 2022. Two carbapenem antibiotic stewardship programme interventions were implemented sequentially: (i) a prospective audit and feedback (PAF) from November 2018 to April 2020 (intervention 1), and (ii) preauthorization from May 2020 to August 2020 (intervention 2). Monthly carbapenem usage and incidence of CR-GNB before and after each intervention were compared using an autoregressive integrated moving average model.

FINDINGS

Implementation of PAF resulted in a significant reduction in carbapenem consumption, followed by an additional decrease after the preauthorization was implemented. The incidence of carbapenem-resistant Escherichia coli and Klebsiella pneumoniae increased after intervention 1, but there was a significant change from an increasing trend to a stationary trend after intervention 2. The incidence of carbapenem-resistant Pseudomonas aeruginosa, which had increased during the baseline period, became stationary after intervention 1. A significant decrease was observed in the incidence of carbapenem-resistant Acinetobacter baumannii during the implementation of intervention 1 and 2.

CONCLUSION

This study emphasizes the importance of adopting comprehensive antibiotic management and rigorous infection control to prevent infections caused by antibiotic-resistant bacteria.

Appropriateness of antibiotic use for patients with asymptomatic bacteriuria or urinary tract infection with positive urine culture: a retrospective observational multi-centre study in Korea

BACKGROUND

Antibiotic resistance threatens public health worldwide, and inappropriate use of antibiotics is one of the main causes.

AIM

To evaluate qualitative use of antibiotics in asymptomatic bacteriuria (ABU) and urinary tract infection (UTI).

METHODS

Cases of positive urine culture (≥105 colony-forning units/mL) performed in inpatient, outpatient and emergency departments in April 2021 were screened in 26 hospitals in the Republic of Korea. The cases were classified as ABU, lower UTI and upper UTI. The appropriateness of antibiotic use was evaluated retrospectively by infectious disease specialists using quality indicators based on clinical guidelines for ABU and UTI.

RESULTS

This study included a total of 2697 patients with ABU or UTI. The appropriateness of antibiotic use was assessed in 1157 patients with ABU, and in 677 and 863 patients with lower and upper UTI, respectively. Among the 1157 patients with ABU, 251 (22%) were prescribed antibiotics without appropriate indications. In 66 patients with ABU in which antibiotics were prescribed with appropriate indications, the duration was adequate in only 23 (34.8%) patients. The appropriateness of empirical and definite antibiotics was noted in 527 (77.8%) and 353 (68.0%) patients with lower UTI, and 745 (86.3%) and 583 (78.2%) patients with upper UTI, respectively. The duration of antibiotics was adequate in 321 (61.8%) patients with lower UTI and 576 (78.7%) patients with upper UTI.

CONCLUSIONS

This nationwide qualitative assessment of antibiotic use in ABU and UTI revealed that antibiotics were often prescribed inappropriately, and the duration of antibiotics was unnecessarily prolonged.

The Mediating Role of Social Participation in Motoric Cognitive Risk and its Relation to Depression and Loneliness in Older Adults

BACKGROUND

Motoric cognitive risk syndrome (MCR) reduces the quality of life, independence, and social interaction in older adults. Social participation is a potentially modifiable factor that benefits cognitive and mental health. This study explored the mediating roles of social participation between MCR and depression and between MCR and loneliness.

METHODS

We performed a secondary analysis of data from the 2015-2016 National Social Life, Health, and Aging Project. Slow gait speed and cognitive decline were used to assess MCR. Mediation analysis was applied to two models, both of which used MCR as an exposure and social participation as a mediator. The outcomes were depression and loneliness for each model, respectively.

RESULTS

Among 1,697 older adults, 196 (11.6%) had MCR. The mediating role of social participation was statistically significant in both models. The indirect effect (β=0.267, p=0.001) of MCR on depression through social participation comprised 11.97% of the total effect (β=2.231, p&lt;0.001). The indirect effect (β=0.098, p=0.001) of MCR on loneliness through social participation was 19.48% of the total effect (β=0.503, p&lt;0.001).

CONCLUSION

Interventions to increase social participation may reduce depression and loneliness of older adults with MCR.

Effect of Physical Activity on Association between COVID-19 and Personal Life in Community-Dwelling Older Adults

Our study investigated whether changes in physical activity due to COVID-19 mediate the association between quarantine or hospitalization due to COVID-19 and COVID-19 life impact score. A total of 154 participants (0.23%) were quarantined or hospitalized due to COVID-19. There were mediating effects of changes in physical activity due to COVID-19 (β = -1.63, 95% confidence interval = -0.77 to -2.42). This study suggests that measures to minimize lifestyle changes during the pandemic are required to reduce negative consequences.

Natural aging and Alzheimer's disease pathology increase susceptibility to focused ultrasound-induced blood-brain barrier opening

Focused Ultrasound (FUS) paired with systemically-injected microbubbles (μB) is capable of transiently opening the blood-brain barrier (BBBO) for noninvasive and targeted drug delivery to the brain. FUS-BBBO is also capable of modulating the neuroimmune system, further qualifying its therapeutic potential for neurodegenerative diseases like Alzheimer's disease (AD). Natural aging and AD impose significant strain on the brain and particularly the BBB, modifying its structure and subsequently, its functionality. The emerging focus on treating neurodegenerative diseases with FUS-BBBO necessitates an investigation into the extent that age and AD affect the BBB's response to FUS. FUS-BBBO was performed with a 1.5-MHz, geometrically focused transducer operated at 450 kPa and paired with a bolus microbubble injection of 8 × 108 μB/mL. Here we quantify the BBBO, BBB closing (BBBC) timeline, and BBB permeability (BBBP) following FUS-BBBO in male mice with and without AD pathology, aged 10 weeks, one year, or two years. The data presented herein indicates that natural aging and AD pathology may increase initial BBBO volume by up to 34.4% and 40.7% respectively, extend BBBC timeline by up to 1.3 and 1.5 days respectively, and increase BBBP as measured by average Ktrans values up to 80% and 86.1% respectively in male mice. This characterization of the BBB response to FUS-BBBO with age and AD further clarifies the nature and extent of the functional impact of these factors and may offer new considerations for planning FUS-BBBO interventions in aged and AD populations.

Association Between COVID-19 and Activities of Daily Living in Older Adults

Older adults gradually decrease their independence with activities of daily living (ADL) due to aging. The coronavirus disease-19 (COVID-19), the recent pandemic, can accelerate the decline in functions, such as ADL. This study aimed to examine whether there is an association between positive COVID-19 results and decreased independence with ADL in older adults. Data for a total of 3,118 older adults were extracted from the 2020 National Health and Aging Trends Study-COVID-19. A total of 71 (2.29%) participants presented with positive COVID-19 tests. There was a significant association between a positive COVID-19 result and decreased independence with ADL (relative risk [RR] = 1.47, 95% confidence interval [CI] = [1.11, 1.96], p = .0079). The study findings revealed that COVID-19 survivors had a high risk of decreased independence with ADL. These findings indicate that COVID-19 survivors have residual functional deficits and would need comprehensive health care services.

Risk of transmission of COVID-19 from healthcare workers returning to work after a 5-day isolation, and kinetics of shedding of viable SARS-CoV-2 variant B.1.1.529 (Omicron)

BACKGROUND

There have been limited data on the risk of onward transmission from individuals with Omicron variant infections who return to work after a 5-day isolation.

AIM

To evaluate the risk of transmission from healthcare workers (HCWs) with Omicron variant who returned to work after a 5-day isolation and the viable-virus shedding kinetics.

METHODS

This investigation was performed in a tertiary care hospital, Seoul, South Korea. In a secondary transmission study, we retrospectively reviewed the data of HCWs confirmed as COVID-19 from March 14^th to April 3^rd, 2022 in units with five or more COVID-19-infected HCWs per week. In the viral shedding kinetics study, HCWs with Omicron variant infection who agreed with daily saliva sampling were enrolled between February and March, 2022.

FINDINGS

Of the 248 HCWs who were diagnosed with COVID-19 within 5 days of the return of an infected HCW, 18 (7%) had contact with the returned HCW within 1-5 days after their return. Of these, nine (4%) had an epidemiologic link other than with the returning HCW, and nine (4%) had contact with the returning HCW, without any other epidemiologic link. In the study of the kinetics of virus shedding (N = 32), the median time from symptom onset to negative conversion of viable virus was four days (95% confidence interval: 3-5).

CONCLUSION

Our data suggest that the residual risk of virus transmission after 5 days of isolation following diagnosis or symptom onset is low.

β-Delayed One and Two Neutron Emission Probabilities Southeast of ^{132}Sn and the Odd-Even Systematics in r-Process Nuclide Abundances

The β-delayed one- and two-neutron emission probabilities (P_{1n} and P_{2n}) of 20 neutron-rich nuclei with N≥82 have been measured at the RIBF facility of the RIKEN Nishina Center. P_{1n} of ^{130,131}Ag, ^{133,134}Cd, ^{135,136}In, and ^{138,139}Sn were determined for the first time, and stringent upper limits were placed on P_{2n} for nearly all cases. β-delayed two-neutron emission (β2n) was unambiguously identified in ^{133}Cd and ^{135,136}In, and their P_{2n} were measured. Weak β2n was also detected from ^{137,138}Sn. Our results highlight the effect of the N=82 and Z=50 shell closures on β-delayed neutron emission probability and provide stringent benchmarks for newly developed macroscopic-microscopic and self-consistent global models with the inclusion of a statistical treatment of neutron and γ emission. The impact of our measurements on r-process nucleosynthesis was studied in a neutron star merger scenario. Our P_{1n} and P_{2n} have a direct impact on the odd-even staggering of the final abundance, improving the agreement between calculated and observed Solar System abundances. The odd isotope fraction of Ba in r-process-enhanced (r-II) stars is also better reproduced using our new data.

The relative importance of left atria reservoir strain compared with components of HFA-PEFF diagnostic algorithm

Background/Introduction

The relative importance of the left atrial reservoir strain (LARS) compared to the parameters constituting the HFA-PEFF score developed as a diagnostic tool for patients with heart failure with preserved ejection fraction (HFpEF) is not well known.

Purpose

We aimed to identify the relative importance of LARS compared with variables associated with HFpEF and HFA-PEFF score including echocardiographic parameters, demographic data, and NT-proBNP.

Methods

From August 2021 to March 2022, we obtained data retrospectively from the participants visiting our clinic in a single cardiovascular center. The 1,252 participants with sinus rhythm and ejection fraction more than 50% were enrolled in the present study (61.8±16.6 years and 55% female). Multivariable regression analysis using backward elimination and random forest analysis, supervised learning algorithm, were performed to identify the relative importance of LARS on the HFA-PEFF score.

Results

The median HFA-PEFF score was 3 points (interquartile range 2 to 4 points). Two hundred forty-one subjects (19.2%) had more than 5 points. LARS showed a moderate correlation with the HFA-PEFF score (r=−0.632, p&lt;0.001). In multivariable regression analysis, LARS was independent variable affecting HFA-PEFF score with female sex, left atrial volume index (LAVI), septal e', E over e' (septal), the maximal tricuspid regurgitation velocity (TR-Vmax), left ventricular global longitudinal strain (LV-GLS), NT-proBNP, interventricular septal wall thickness (standardized β=−0.106; P&lt;0.001). In random forest analysis, LARS was a more relatively important variable than TR-Vmax, NT-proBNP, septal E/e', septal e', the major echocardiographic components of HFA-PEFF score estimating more than 5 points of HFA-PEFF score.

Conclusions

LA reservoir strain is one of the important factors with components of the HFA-PEFF score which is a useful tool to assess the patients with HFpEF.

Funding Acknowledgement

Type of funding sources: None.

The Role of Physical Activity and Depression on Quality of Life in Community-Dwelling Older Adults: Using Propensity Score Matching Approaches

This study examined the association between achieving the recommended physical activity level and quality of life after controlling for depression. Health information from adults aged 65 years and older, who had participated in the seventh 2018 Korea National Health and Nutrition Examination Survey, was used. Five covariate adjustment models were used to derive robust estimates of the association between physical activity practice levels, depression, and older adults' quality of life. A total of 1,336 older adults was extracted from the seventh 2018 Korea National Health and Nutrition Examination Survey, and 31% of the older adults achieved the recommended physical activity level, whereas 69% did not. We found that the achievement of physical activity practice levels is significantly associated with the quality of life of the older adults (β = 0.024-0.031, all p < .05). Our results could be used for advocating for welfare policy changes that promote physical activity to prepare for the upcoming super-aging society.

Search for Subsolar-Mass Binaries in the First Half of Advanced LIGO's and Advanced Virgo's Third Observing Run

We report on a search for compact binary coalescences where at least one binary component has a mass between 0.2  M_{⊙} and 1.0  M_{⊙} in Advanced LIGO and Advanced Virgo data collected between 1 April 2019 1500 UTC and 1 October 2019 1500 UTC. We extend our previous analyses in two main ways: we include data from the Virgo detector and we allow for more unequal mass systems, with mass ratio q≥0.1. We do not report any gravitational-wave candidates. The most significant trigger has a false alarm rate of 0.14  yr^{-1}. This implies an upper limit on the merger rate of subsolar binaries in the range [220-24200]  Gpc^{-3} yr^{-1}, depending on the chirp mass of the binary. We use this upper limit to derive astrophysical constraints on two phenomenological models that could produce subsolar-mass compact objects. One is an isotropic distribution of equal-mass primordial black holes. Using this model, we find that the fraction of dark matter in primordial black holes in the mass range 0.2  M_{⊙}<m_{PBH}<1.0  M_{⊙} is f_{PBH}≡Ω_{PBH}/Ω_{DM}≲6%. This improves existing constraints on primordial black hole abundance by a factor of ∼3. The other is a dissipative dark matter model, in which fermionic dark matter can collapse and form black holes. The upper limit on the fraction of dark matter black holes depends on the minimum mass of the black holes that can be formed: the most constraining result is obtained at M_{min}=1  M_{⊙}, where f_{DBH}≡Ω_{DBH}/Ω_{DM}≲0.003%. These are the first constraints placed on dissipative dark models by subsolar-mass analyses.

Association Between Social Participation and Cognitive Function in Community-Dwelling Adults

Social participation is associated with cognitive function; however, their causal relationships have not been reported yet. This study was designed to examine the autoregressive effects and bidirectional causal relationship between social participation and cognitive function. In this secondary longitudinal data analysis, we enrolled 4,834 Korean adults. A cross-lagged panel model with fixed effects was used to examine the causal relationships between social participation and cognitive function. Both participation (unstandardized coefficient = .370, p < .001) and cognitive function (unstandardized coefficient = .151, p < .001) had positive autoregressive effects over time. Participation had a cross-lagged effect on cognitive function (unstandardized coefficient = .061, p < .001). However, the cross-lagged effects of cognitive function on participation were not statistically significant (unstandardized coefficient = .051, p = .312). Various health-care programs that promote social participation and improve cognitive function must be established. Additional studies are required to confirm the causal effects of cognitive function on participation.

Item-level psychometrics of the Ascertain Dementia Eight-Item Informant Questionnaire

The aim of this study is to evaluate the item-level psychometrics of the Ascertain Dementia Eight-Item Informant Questionnaire (AD-8) by examining its dimensionality, rating scale integrity, item fit statistics, item difficulty hierarchy, item-person match, and precision. We used confirmatory factor analysis and the Rasch rating scale model for analyzing the data extracted from the proxy versions of the 2019 and 2020 National Health and Aging Trends Study, USA. A total of 403 participants were included in the analysis. The confirmatory factor analysis with a 1-factor model using the robust weighted least squares (WLSMV) estimator indicated a unidimensional measurement structure (χ² = 41.015, df = 20, p = 0.004; root mean square error of approximation = 0.051; comparative fit index = 0.995; Tucker–Lewis Index = 0.993;). The findings indicated that the AD-8 has no misfitting items and no differential item functioning across sex and gender. The items were evenly distributed in the item difficulty rating (range: −2.30 to 0.98 logits). While there were floor effects, the AD-8 revealed good reliability (Rasch person reliability = 0.67, Cronbach’s alpha = 0.89). The Rasch analysis reveals that the AD-8 has excellent psychometric properties that can be used as a screening assessment tool in clinical settings allowing clinicians to measure dementia both quickly and efficiently. To summarize, the AD-8 could be a useful primary screening tool to be used with additional diagnostic testing, if the patient is accompanied by a reliable informant.

Assessing The Utility of D-Dimer Driven Anticoagulation Strategies In Severely Obese Patients With COVID-19

Funding Acknowledgements

Type of funding sources: None.

Background

Many studies to date have documented significant inflammatory vascular sequelae in association with COVID-19. Current guidelines suggest an initial strategy of therapeutic-dose anticoagulation to non-critically ill, hospitalized patients requiring low-flow oxygen and a concurrent D-dimer level above the upper limit of normal. However, the utility of D-dimer values in predicting thrombosis in severely obese patients are equivocal to poor, with prior evidence suggesting falsely elevated levels with greater BMI. Given the weight-based dosing of heparin, these patients may also be inadvertently at elevated risk for major bleeds.

Purpose

To examine the utility of D-dimer levels in risk stratification and anticoagulation therapy in non-critically ill COVID-19 patients with severe obesity.

Methods

In this single-center, retrospective study, 32 severely obese patients (defined as BMI > 40) hospitalized with COVID-19 and requiring low flow oxygen delivery, without ICU level of care were analyzed. Clinical outcomes were compared between groups receiving therapeutic versus prophylactic doses of anticoagulation. All were treated with low molecular weight heparin (LMWH) per hospital protocol. The following data points were examined: length of hospitalization, mortality, anticoagulation therapy, initial d-dimer levels, thrombotic events, minor/major bleeds, and oxygen modality.

Results

In total, 78% of patients initially presented with a D-dimer level above the upper limit of normal, with 53% of patients meeting criteria for therapeutic anticoagulation. However, there were no significant differences in incidence of thrombotic events, mean length of hospitalization or overall mortality. Furthermore, despite utilization of appropriate therapeutic anticoagulation, it did not reduce the overall use of oxygen support requirements, including high flow oxygen or non-invasive ventilation, when compared to individuals receiving prophylactic dosing.

Conclusion

The clinical utility of D-dimer levels for guiding anticoagulation therapy in severely obese patients with COVID-19 may be limited. Here, we demonstrate that therapeutic dose approaches have nonsignificant differences in clinical outcomes when compared to prophylactic doses in this distinct population.

The Effects of Dual-Task Training for Older Adults With Cognitive Impairment: A Systematic Review

Date Presented 04/02/2022

The study aims to review the dual-task training effects on cognitive function of older adults with dementia and mild cognitive impairment. The five selected studies examined simultaneous dual-task training, and their interventions showed significant effects on cognitive function, executive function, and psychomotor speed. These significant effects indicate that simultaneous dual-task training can be used in clinical practice with older adults with dementia and mild cognitive impairment .

Primary Author and Speaker: Yeonju Jin

Additional Authors and Speakers: Yumi Ju, Nam Sanghun, Suyeong Bae, Ickpyo Hong

COVID-19, Life, and Physical Activity in Community-Dwelling Older Adults: A Mediation Analysis

Date Presented 03/31/2022

The study aims to analyze the association between isolation and hospitalization due to COVID-19 and life of older adults. In addition, the aim is to examine the association of changes in physical activity between the two factors. Isolation and hospitalization due to COVID-19 were associated with a decrease in physical activity and life. The results emphasize the importance of physical activity in quarantine and hospitalization resulting from COVID-19.

Primary Author and Speaker: Suyeong Bae

Additional Authors and Speakers: Ickpyo Hong

Development of Cognitive and Physical Function Measurement Scales for Older Adults in China, Japan, and Korea

Date Presented 03/31/2022

The purpose of this study was to develop a scale that can measure the cognitive and physical functions of older adults in China, Japan, and Korea and to compare the health function across the three Asian countries. Scale anchoring with Rasch modeling was performed using three aging panel survey databases to obtain 13 cognitive function items and 20 physical function items. The study findings showed that Japan had the highest physical and cognitive functions of the three countries.

Primary Author and Speaker: Nam Sanghun

Additional Authors and Speakers: Suyeong Bae, Ickpyo Hong

Social, behavioural, and functional characteristics of community-dwelling South Korean adults with moderate and severe cognitive impairment

OBJECTIVES

This study used the 2016 Korean Longitudinal Study on Aging to investigate the social, behavioural, and functional characteristics of community-dwelling South Korean adults with cognitive impairment.

METHODS

Participants were classified as normal, moderate impairment, and severe impairment according to an algorithm that combined the Korean Mini-Mental State Examination score and the number of difficulties in performing instrumental activities of daily living. Selected characteristics included grip strength, depression, participation in exercise and social activities, and living in a rural, urban, or suburban community.

RESULTS

Most (72.7%) participants were classified as having normal cognition, 20.1% were classified as moderate impairment, and 7.2% were classified as severe impairment. Regardless of sex, the differences in grip strength across the cognitive status classifications were statistically significant, except for the difference between moderate and severe cognitive impairment in males (p = 0.8477). Greater number of depressive symptoms and living in rural areas were associated with significantly higher odds for severe cognitive impairment. Participants with moderate (OR = 0.51) and severe (OR = 0.33) cognitive impairment were less likely to participate in social activities than those with normal cognition.

CONCLUSIONS

The study findings revealed that social, behavioural, and functional characteristics are closely related to the cognitive status of community-dwelling adults in South Korea.

Association between divorce and access to healthcare services among married immigrants: propensity score approaches

Background

While divorce is a social determinant of health among married immigrants in Korea, its association with access to healthcare services is unclear. Given the rapid increase in the number of married immigrants in Korea, research is needed to improve minority groups’ access to healthcare services. Here, we examined healthcare service utilization among married immigrants.

Methods

We retrieved 11,778 adults from the 2018 Korea National Multicultural Family Survey. We analyzed whether the sex of divorced immigrants is associated with healthcare access using multivariable logistic regression analysis. Further, we analyzed the association between divorce and access to healthcare services among married immigrants using propensity score matching methods.

Results

There were 691 (5.8%) divorced immigrants in the data set. The married male immigrants had no association between divorce status and healthcare access (adjusted odds ratio [OR] = 1.05, 95% confidence interval [CI] = 0.55–2.03, p = 0.8620). Divorced immigrants were less likely to receive healthcare services than married immigrants (adjusted OR = 1.42, 95% CI = 1.07–1.88).

Conclusion

Our findings revealed that divorce increases the risk of limited access to healthcare services among married immigrants. Policymakers and healthcare providers should be aware of these potential disparities in this vulnerable minority population.

Study Protocol of a Comprehensive Activity Promotion Program for the Prevention of Dementia: A Randomized Controlled Trial Protocol

BACKGROUND

Several technical devices are available to monitor and promote changes in behavior toward higher activity. In particular, smartphones are becoming the primary platform for recognizing human activity. However, the effects of behavior change techniques that promote physical, cognitive, and social activities on incident dementia in older adults remain unknown.

OBJECTIVES

This randomized controlled trial aims to examine the effects of behavior change techniques on the prevention of dementia among community-dwelling older adults using a smartphone as a behavior change tool.

DESIGN

A randomized controlled trial.

SETTING

Community in Japan.

PARTICIPANTS

The study cohort comprises 3,498 individuals, aged ≥60 years, randomized into two groups: the smartphone group (n = 1,749) and the control group (n = 1,749).

INTERVENTION

The smartphone group will be asked to use smartphone applications for at least 30 minutes daily to self-manage and improve their physical, cognitive, and social activities. The smartphone group will perform 60-minute group walking sessions using application-linked Nordic walking poles with cognitive stimulation twice a week during the intervention period. The walking poles are a dual-task exercise tool that works with a smartphone to perform cognitive tasks while walking, and the poles are equipped with switches to answer questions for simple calculation and memory tasks. The smartphone and control groups will receive lectures about general health that will be provided during the baseline and follow-up assessments.

MEASUREMENTS

Incident dementia will be detected using cognitive tests (at baseline, after 15 months, and after 30 months) and by preparing diagnostic monthly reports based on data from the Japanese Health Insurance System. Participants without dementia at baseline who will be diagnosed with dementia over the 30-month follow-up period will be considered to have incident dementia.

CONCLUSIONS

This study has the potential to provide the first evidence of the effectiveness of information communication technology and Internet of Things in incident dementia. If our trial results show a delayed dementia onset for self-determination interventions, the study protocol will provide a cost-effective and safe method for maintaining healthy cognitive aging.

Association of Daily Physical Activity with Disability in Community-Dwelling Older Adults With/Without Chronic Kidney Disease

OBJECTIVES

Physical activity is recommended for disability prevention in the older adult population; however, the level of physical activity required for older adults with chronic kidney disease (CKD) remains unknown. This study aimed to examine the associations between daily physical activity and disability incidence in older adults with and without CKD to determine relevant daily physical activity levels.

DESIGN

Prospective observational study.

SETTING AND PARTICIPANTS

3,786 community-dwelling older adults aged ≥65 years.

MEASUREMENTS

Mean daily times spent in light- (LPA) and moderate-to-vigorous physical activity (MVPA) were measured using triaxial accelerometers. CKD was defined by a creatinine estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. Disability incidence was identified as long-term care insurance certification during a 60-month follow-up period. Associations between physical activity and disability incidence were examined using Cox proportional hazard models stratified by the CKD status. Non-linear and linear associations were tested using the restricted cubic spline.

RESULTS

A total of 1,054 individuals were identified to have CKD. Disability incidence was higher in the CKD group than in the non-CKD group. The adjusted cox proportional hazard models indicated that a 10-minute increase in MVPA time was associated with lower disability incidence in the non-CKD group (hazard ratio [HR], 0.838; 95% confidence interval [CI]: 0.764-0.918) and the CKD group (HR, 0.859; 95% CI: 0.766-0.960). Linear associations were observed in MVPA for the non-CKD and CKD groups.

CONCLUSION

Increasing MVPA was associated with lower disability incidence in older adults with and without CKD. These findings can help devise disability prevention strategies for older CKD patients.

Association between Non-Face-to-Face Interactions and Incident Disability in Older Adults

OBJECTIVES

This observational prospective cohort study, conducted between September 2015 and February 2019, aimed to investigate the association between the incidence of disability and non-face-to-face interactions among community-dwelling older adults in Japan.

DESIGN

Participants reported their interaction status using a self-report questionnaire. Face-to-face interactions comprised in-person meetings, while virtual interactions (e.g., via phone calls or emails) were defined as non-face-to-face interactions. We examined the relationship between their interaction status at baseline and the risk of disability incidence at follow-up. We also considered several potential confounding variables, such as demographic characteristics.

SETTING

The National Center for Geriatrics and Gerontology-Study of Geriatric Syndromes.

PARTICIPANTS

We included 1159 adults from Takahama City aged ≥75 years (mean age ± standard deviation = 79.5 ± 3.6 years).

MEASUREMENTS

Interaction status was assessed using a self-reported questionnaire consisting of two sections (face-to-face and non-face-to-face interactions), and four questionnaire items. Based on the responses we categorized study participants into four groups: "both interactions," "face-to-face only," "non-face-to-face only," and "no interactions."

RESULTS

Individuals with both kinds of interactions (49.3/1000 person-years) or only one kind of interaction (face-to-face = 57.7/1000 person-years; non-face-to-face = 41.2 person-years) had lower incidence of disability than those with no interactions (88.9/1000 person-years). Moreover, the hazard ratios adjusted for potential confounding factors for the incidence of disability in the both interaction, face-to-face-only, and non-face-to-face only groups were 0.57 (confidence interval = 0.39-0.82; p = 0.003), 0.66 (confidence interval = 0.44-0.98; p = 0.038), and 0.47 (confidence interval = 0.22-0.99; p = 0.048), respectively.

CONCLUSION

Considering the interaction status of older adults in their day-to-day practice, clinicians may be able to achieve better outcomes in the primary prevention of disease by encouraging older adults to engage in any form of interaction, including non-face-to-face interactions.

Analysis of 29 Items of the Meaningful Activity Participation Assessment-Meaningful Scale Through Rasch Analysis

Individuals find meaning in their personal activities. Meaningful activities can improve an individual's emotional and physical health and quality of life. The Meaningful Activity Participation Assessment-Meaningful Scale (MAPA-M), which can measure these meaningful activities, is measured in 29 items. In this study, the psychometric properties of 29 items of MAPA-M were investigated through Rasch analysis. The data used in this study was the Well Elderly Study 2 data among public data provided by the Inter-university Consortium for Political and Social Research (ICPSR). We used 480 randomized samples from the Well Elderly Study 2 data. Before proceeding with the Rasch analysis, as a result of checking the unidimensionality assumption of 29 items, 19 items satisfied the unidimensionality assumption. As a result of Rasch analysis of 19 items, the Driving item was removed as misfit (infit mean-square = 2.04, infit z-standardized fit statistics = 9.90, outfit mean-square = 1.86, outfit z-standardized fit statistics = 8.99). The 18 items with the misfit items removed show a conceptual item-difficulty hierarchy, and there was no differential item functioning that worked for sex and age groups. The person strata value is 3.97, which corresponds to the confidence value of 0.88. These results indicate that the 18 items in MAPA-M show appropriate item-level psychometric properties. In other words, the modified MAPA-M 18 indicates that meaningful activities can be accurately and stably measured.

Comparison of Association Between Divorce and Access to Healthcare Services Among Married Immigrants

The number of married immigrants is increasing in Korea, and family dissolution is also growing in this population. Although divorce could impact immigrants' health status, it is unclear whether they have difficulties accessing healthcare and medical services. Thus, we examined whether divorce in married immigrants is independently associated with access to healthcare services. A retrospective analysis of 11,778 adults who participated in the 2018 National Multicultural Family Survey. We used three different covariate adjustment methods (multivariate logistic regression, inverse probability of treatment weighting, 1:1 greedy propensity score matching) to examine the association between divorce and access to healthcare services after accounting for various demographic and clinical characteristics. Overall, 5.8% (n = 691) of married immigrants reported a history of divorce. The divorce group included 107 (15.5%) males and 584 (84.5%) females, with an average age of 45.17 years (SD = 10.9). The non-divorced group included 1992 males (18.0%) and 9095 (82.0%) females, with an average age of 39.1 years (SD = 10.5). After propensity score matching, all variables were balanced (all p>0.05). Individuals who experienced divorce were more likely to have difficulties in healthcare service access than those who did not experience divorce (adjusted odds ratio 1.423, 95% CI [1.075, 1.882]). Our findings revealed that divorce increased the risk of limited healthcare services among immigrants in Korea. Healthcare policymakers should be aware of the healthcare access issues in this minority population. In addition, to improve the lifestyles of minority populations, it is necessary to study their overall lives.

Psychometric Properties of the Health Literacy Survey European Questionnaire-12

The importance of health literacy has increased as the public awareness of health has increased. Health Literacy Survey European Questionnaire-47 (HLS-EU-Q47) is a representative assessment tool for evaluating health literacy, and its psychometric properties have been examined in various countries. This study analyzed the item-level psychometric properties of a short version of the HLS-EU-Q47 using a Rasch measurement model. We collected 254 Korean adults who completed the 12 items of the HLS-EU-Q47 in hospital settings. We used confirmation factor analysis (CFA) to examine the unidimensionality assumption of the HLS-EU-Q12. We analyzed item fit, precision, and differential item functioning (DIF) across sex, age and education groups. The CFA model confirmed that HLS-EU-Q12 satisfies the unidimensionality assumption (CFI = 0.96, TLI = 0.96, RMSEA = 0.09) and no local independence in the 12 test items (residual correlations ranged from -0.16 to 0.19). The HLS-EU-Q12 demonstrated high reliability (Cronbach’s α = 0.90) and no DIF across sex, age and education groups (p &gt; 0.05). The person strata by the instrument were 3.80, which is equivalent to a traditional reliability value of 0.87. In short, the study findings indicate that the HLS-EU-Q12 has good psychometric properties with the 254 Korean adults. Since the HLS-EU-Q12 can accurately and precisely evaluate the health literacy of Korean adults, this instrument could be used in clinical settings.

COVID-19 has Affected Activities of Daily Living in Older Adults?

Research Objectives

To investigate that Coronavirus disease (COVID-19)has affected to performed activities of daily living, we analyzed the association between confirmation of COVID-19 and help in activities of daily living.

Design

Our study was a cross-sectional study using secondary data.

Setting

The participants were living in the general community and residential care and nursing home.

Participants

We used 3119 adult observations in the 2020 COVID-19 National Health and Aging Trends Study (NHATS). We are separate the group by confirmed of COVID-19.

Interventions

Not applicable.

Main Outcome Measures

The dependent variable of study was the frequency of help in activity of daily living. In the NHATS survey, the question is follow as “During the COVID-19 outbreak, has anyone ever helped you with sub-item relative activities of daily living?”. The answer was yes or no. We summed the number of yes and used it as the dependent variable. The independent variable was confirmed of COVID-19.

Results

We applied multiple imputation methods due to missing data. When removing the missing data, Yes-COVID-19 group was 26 and No-COVID-19 group was 2091. The Yes-COVID-19 group was composed of 18 males (45.00%) and 22 females (55.00%). The No-COVID-19 group was composed of 1299 males (42.20%) and 1779 (57.80%). The Yes-COVID-19 group was living in general community (n=32, 80.00%), residential care (n=5, 12.50%) and nursing home (n=3, 7.50%). The No-COVID-19 group was living in general community (n=2889, 93.86%), residential care (n=161, 5.23%) and nursing home (n=28, 0.91%). The frequency of help in activity of daily living was Yes-COVID-19 group higher than No-COVID-19 group. In addition, the relative risk of help in activity of daily living was Yes-COVID-19 group higher than No-COVID-19 (relative risk=1.84, 95% confidence level=1.59-2.08, p < .0001).

Conclusions

Our study is confirmed COVID-19 is affected activity of daily living in older adults. Our finding is suggested that the need for the rehabilitation program after confirmation of COVID-19. Also, we need to investigate the research of demand in a rehabilitation program.

Author(s) Disclosures

All authors declares that he has no conflict of interest.

Clustering and multiple-spreading events of nosocomial severe acute respiratory syndrome coronavirus 2 infection

Background

There is growing evidence that super-spreading events (SSEs) and multiple-spreading events (MSEs) are a characteristic feature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, data regarding the possibility of SSEs or MSEs in healthcare settings are limited.

Methods

This study was performed at a tertiary-care hospital in Korea. We analysed the nosocomial COVID-19 cases that occurred in healthcare workers and inpatients and their caregivers between January and 20^th December 2020. Cases with two to four secondary cases were defined as MSEs and those with five or more secondary cases as SSEs.

Findings

We identified 21 nosocomial events (single-case events, N = 12 (57%); MSE + SSE, N = 9 (43%)) involving 65 individuals with COVID-19. Of these 65 individuals, 21 (32%) were infectors. The infectors tended to have a longer duration between symptom onset and diagnostic confirmation than did the non-infectors (median two days vs zero days, P=0.08). Importantly, 12 (18%) individuals were responsible for MSEs and one (2%) for an SSE, which collectively generated 35 (54%) secondary cases.

Conclusion

In a hospital with thorough infection-control measures, approximately 70% of the nosocomial cases of COVID-19 did not generate secondary cases, and one-fifth of the infectors were responsible for SSEs and MSEs, which accounted for approximately half of the total cases. Early case identification, isolation, and extensive contact tracing are important for the prevention of transmission and SSEs.

Constraints on Cosmic Strings Using Data from the Third Advanced LIGO-Virgo Observing Run

We search for gravitational-wave signals produced by cosmic strings in the Advanced LIGO and Virgo full O3 dataset. Search results are presented for gravitational waves produced by cosmic string loop features such as cusps, kinks, and, for the first time, kink-kink collisions. A template-based search for short-duration transient signals does not yield a detection. We also use the stochastic gravitational-wave background energy density upper limits derived from the O3 data to constrain the cosmic string tension Gμ as a function of the number of kinks, or the number of cusps, for two cosmic string loop distribution models. Additionally, we develop and test a third model that interpolates between these two models. Our results improve upon the previous LIGO-Virgo constraints on Gμ by 1 to 2 orders of magnitude depending on the model that is tested. In particular, for the one-loop distribution model, we set the most competitive constraints to date: Gμ≲4×10^{-15}. In the case of cosmic strings formed at the end of inflation in the context of grand unified theories, these results challenge simple inflationary models.

Constraints on Cosmic Strings Using Data from the Third Advanced LIGO-Virgo Observing Run

We search for gravitational-wave signals produced by cosmic strings in the Advanced LIGO and Virgo full O3 dataset. Search results are presented for gravitational waves produced by cosmic string loop features such as cusps, kinks, and, for the first time, kink-kink collisions. A template-based search for short-duration transient signals does not yield a detection. We also use the stochastic gravitational-wave background energy density upper limits derived from the O3 data to constrain the cosmic string tension Gμ as a function of the number of kinks, or the number of cusps, for two cosmic string loop distribution models. Additionally, we develop and test a third model that interpolates between these two models. Our results improve upon the previous LIGO-Virgo constraints on Gμ by 1 to 2 orders of magnitude depending on the model that is tested. In particular, for the one-loop distribution model, we set the most competitive constraints to date: Gμ≲4×10^{-15}. In the case of cosmic strings formed at the end of inflation in the context of grand unified theories, these results challenge simple inflationary models.

Development and Validation of a Deep Learning-Based Model to Distinguish Glioblastoma from Solitary Brain Metastasis Using Conventional MR Images

BACKGROUND AND PURPOSE

Differentiating glioblastoma from solitary brain metastasis preoperatively using conventional MR images is challenging. Deep learning models have shown promise in performing classification tasks. The diagnostic performance of a deep learning-based model in discriminating glioblastoma from solitary brain metastasis using preoperative conventional MR images was evaluated.

MATERIALS AND METHODS

Records of 598 patients with histologically confirmed glioblastoma or solitary brain metastasis at our institution between February 2006 and December 2017 were retrospectively reviewed. Preoperative contrast-enhanced T1WI and T2WI were preprocessed and roughly segmented with rectangular regions of interest. A deep neural network was trained and validated using MR images from 498 patients. The MR images of the remaining 100 were used as an internal test set. An additional 143 patients from another tertiary hospital were used as an external test set. The classifications of ResNet-50 and 2 neuroradiologists were compared for their accuracy, precision, recall, F1 score, and area under the curve.

RESULTS

The areas under the curve of ResNet-50 were 0.889 and 0.835 in the internal and external test sets, respectively. The area under the curve of neuroradiologists 1 and 2 were 0.889 and 0.768 in the internal test set and 0.857 and 0.708 in the external test set, respectively.

CONCLUSIONS

A deep learning-based model may be a supportive tool for preoperative discrimination between glioblastoma and solitary brain metastasis using conventional MR images.

In vitro antibacterial effects of non-thermal atmospheric plasma irradiation on Staphylococcus pseudintermedius and Pseudomonas aeruginosa

In the last decade, atmospheric plasma has been used to treating bacterial infections in humans due to its bactericidal effects; however, its efficacy in dogs is unclear. This study evaluated the in vitro bactericidal efficacy of atmospheric plasma on Staphylococcus pseudinter- medius and Pseudomonas aeruginosa, two of the most important bacterial agents isolated from canine pyodermas. Three isolates each of S. pseudintermedius and P. aeruginosa obtained from dogs with pyoderma were subjected to atmospheric plasma. The isolates from the control group were not exposed to plasma, while those from the treatment groups were exposed to plasma for 15 (7.5 J/cm2), 30 (15 J/cm2), 60 (30 J/cm2), or 90 (45 J/cm2) seconds. After each treatment, a reduction in colony formation was observed. Bacterial viability was evaluated using the LIVE/ DEAD® BacLight™ Bacterial Viability Kit. The antibacterial effects were evaluated with Image J software and significance was assessed statistically in comparison to the control group. The bactericidal effect of atmospheric plasma against both bacteria increased significantly in a time-dependent manner. These results demonstrate the bactericidal capacity of atmospheric plasma, and suggest that it could serve as an alternative treatment method for canine pyoderma. Further studies are needed to evaluate the safety and efficacy of atmospheric plasma in dogs.

Cross-National Comparisons of Cognitive and Physical Health in Older Adults Across China, Japan, and Korea: A Systematic Review

Background

Cross-national studies are an emerging research area in public health. Specifically, cross-national health comparisons are important for understanding the factors driving the success or failure of public health policies. Therefore, this study systematically analyzed studies that compared health status (physical health and cognition) of the older adults using national panel data for three East Asian countries—China, Japan, and Korea.

Methods

Google Scholar and PubMed were used for the literature search. The search strategy targeted papers published between 2005 and 2020, yielding a total of 2690 papers, of which seven were selected for the review. The Center for Evidence-Based Medicine (CEBM) criteria was used to assess study design quality. The risk of bias for non-randomized studies (RoBANS) tool, a quality assessment tool developed in Korea to evaluate non-randomized interventional studies, measured risk of bias.

Results

Of the seven included papers, two studies performed cognitive comparisons, four studies performed physical health comparisons, and one study compared both cognition and physical health. The studies selected for this study by CEBM criteria included four prospective cohort studies (Level 2B) and three expert opinions without explicit critical appraisal (Level 5). Risk of bias using the RoBANS tool found a risk of confounding variables in four out of seven papers. Finally, measurement items of cognitive and physical health differed across all three countries’ panel surveys.

Conclusion

These results suggest that in order to compare East Asian health policies according to the aging society, it is necessary to develop consistent cognitive and physical health evaluation tools in the future.

Supercapacitor performance of porous nickel cobaltite nanosheets

In this work, nickel cobaltite (NiCo2O4) nanosheets with a porous structure were fabricated on nickel foam as a working electrode for supercapacitor applications. The nanosheets were fabricated by electrochemical deposition of nickel-cobalt hydroxide on the nickel foam substrate at ambient temperature in a three-electrode cell followed by annealing at 300 °C to transform the coating into a porous NiCo2O4 nanosheet. Field emission scanning electron microscopy and transmission electron microscopy revealed a three-dimensional mesoporous structure, which facilitates ion transport and electronic conduction for fast redox reactions. For one cycle, the NiCo2O4 electrodeposited nickel foam has a high specific capacitance (1734.9 F g-1) at a current density (CD) of 2 A g-1. The electrode capacitance decreased by only approximately 12.7% after 3500 cycles at a CD of 30 A g-1. Moreover, a solid-state asymmetric supercapacitor (ASC) was built utilising the NiCo2O4 nanosheets, carbon nanotubes, and a polyvinyl alcohol-potassium hydroxide gel as the anode, cathode, and solid-state electrolyte, respectively. The ASC displayed great electrochemical properties with a 42.25 W h kg-1 energy density at a power density of 298.79 W kg-1.

Hyperattenuating lesions after mechanical thrombectomy in acute ischaemic stroke: factors predicting symptomatic haemorrhage and clinical outcomes

AIM

To evaluate the clinical significance of hyperattenuating lesions on CT after mechanical thrombectomy for acute ischaemic stroke, and to identify imaging factors that predict symptomatic haemorrhage and unfavourable outcomes.

MATERIALS AND METHODS

Seventy-eight patients with acute ischaemic stroke in the anterior circulation who underwent mechanical thrombectomy were evaluated. All patients underwent post-interventional unenhanced computed tomography (CT) within 24 h and follow-up CT or magnetic resonance imaging (MRI) within 7 days. Baseline characteristics and clinical outcomes were compared between patients with and without hyperattenuating lesions. In patients with hyperattenuating lesions, clinical and imaging factors that predict symptomatic haemorrhage and unfavourable outcomes were determined.

RESULTS

Fifty-six of 78 patients (71.8%) demonstrated hyperattenuating lesions on post-interventional CT. Patients with hyperattenuating lesions showed lower Alberta Stroke Program Early CT score (ASPECTS), persistent/symptomatic haemorrhage, and unfavourable outcomes than those without. In patients with hyperattenuating lesions, larger hyperattenuating lesion volume (>21.3 ml; OR, 55.60, p<0.001) and perilesional oedema (OR, 46.04, p=0.015) were independent factors predicting symptomatic haemorrhage. Older age (OR, 1.2, p=0.006) and lower ASPECTS (OR, 0.45, p=0.046) were independent factors predicting unfavourable outcomes in patients with hyperattenuating lesions. Adding the volume of the hyperattenuating lesion to age and ASPECTS increased the predictive performance of unfavourable outcomes (area under the curve 0.874 versus 0.934, p=0.043).

CONCLUSIONS

Hyperattenuating lesions on post-interventional CT are associated with increased risk of symptomatic haemorrhage and unfavourable outcomes. Larger hyperattenuating lesion volume is an independent factor of symptomatic haemorrhage and it has added predictive value for unfavourable outcomes.