scholarly journals Predictors of Acute Neurological Worsening after Endovascular Thrombectomy

2019 ◽  
Vol 8 (2-6) ◽  
pp. 172-179 ◽  
Author(s):  
Jazba Soomro ◽  
Liang Zhu ◽  
Sean I. Savitz ◽  
Amrou Sarraj
Keyword(s):  
Retrospective Cohort ◽  
Infarct Volume ◽  
Small Sample Size ◽  
Strong Association ◽  
Small Sample ◽  
Receiver Operating Curve ◽  
Secondary Outcome ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Poor Outcome

Background: Successful reperfusion after endovascular thrombectomy (EVT) correlates with good outcome. However, radiographic reperfusion does not always translate into good clinical outcomes even if the reperfusion occurs early after the stroke onset. Reasons for neurological worsening (NW) are thought to be many, such as progression of the stroke, hemorrhagic conversion post tissue plasminogen activator and/or EVT, and procedural complications such as vessel dissection or perforation, distal emboli, and re-occlusion. Data on patients worsening in the acute phase after EVT are limited. Objective: We studied the factors associated with acute NW and also identified the predictors of NW after EVT and its association with poor outcome at discharge. Methods: A retrospective cohort from a single comprehensive stroke center includes patients with acute ischemic stroke and large vessel occlusion in anterior and posterior circulation who presented between December 2014 and May 2017 and received EVT were reviewed. Primary outcome was defined as acute NW defined as change in NIHSS ≥4 from baseline in the first 24 h after EVT. Secondary outcome were modified Rankin scale (mRS) 0–2 at discharge and final infarct volume. Univariate and multivariate analyses were performed to evaluate clinical and radiographic variables independently correlating with NW after EVT. Receiver operating curve analysis was also performed to identify predictors. Results: 178 patients were included in the analysis, 26 (14.7%) met the criteria for acute NW. For these 178 patients, the median age was 63 (IQR 53–74, range 26–89), baseline median NIHSS was 19 (IQR 14–24, range 5–37), ASPECTS was 8 (IQR 7–9, range 4–10), admission median systolic blood pressure (SBP) was 150 (IQR 131–170, range 94–287), and initial median blood glucose (BG) was 123 (IQR 106–157, range 69–433). The most common reasons for worsening were progression of the stroke (42.3%) and reperfusion injury PH-2 (26.9%) (p < 0.0001). Univariate logistic analysis showed that race, ASPECTS, collateral score, diabetes mellitus, admission SBP, and admission BG were associated with acute NW. In multivariate analysis, only admission BG (OR 1.00, CI 1.00–1.01, p = 0.04) was found to have a significant association with acute NW. We ran a prediction analysis for variables and found the area under the curve to be 0.75. Finally, there was strong association between NW and poor outcome at discharge (MRS 3–6, p < 0.01) by Fisher’s exact test. About 46.1% in the NW group died during hospitalization compared to 10% in the non-NW group (p < 0.0001). Conclusion: Our single-center retrospective cohort result is limited by small sample size. It showed that high admission BG is an independent predictor of NW after EVT and ultimately leads to poor outcome.

scholarly journals 435. Outcomes for E484K Mutation Negative COVID-19 Patients Cohorted with E484K Mutation Positive COVID-19 Patients: A Retrospective Cohort Study

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S319-S319
Author(s):  
Fahad Buskandar ◽  
Amber L Linkneheld-Struk ◽  
Victoria R Williams ◽  
Adrienne Chan ◽  
Lorraine Maze Dit Mieusement ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Small Sample Size ◽  
Acute Infection ◽  
Admission Rate ◽  
Small Sample ◽  
Secondary Outcome ◽  
Hospital Room ◽  
Risk Of Death

Abstract Background The emergence of the E484K mutation of SARS-CoV-2 poses a risk of immune evasion but the risk of re-infection during acute infection is not well defined. Our aim was to assess the risk of re-infection among patients with existing acute E484K mutation negative COVID-19 infection who were exposed to an E484K mutation positive SARS-CoV-2 infected patient. Methods We performed a retrospective cohort study of patients admitted with acute E484K negative COVID-19 infection and shared a hospital room with a patient who was E484K mutation positive during their period of communicability. The primary outcome was laboratory confirmed and/or clinical evidence of re-infection within the E484K negative population within 30 days of exposure and the secondary outcome was the 30-day risk of death or re-admission to hospital due to COVID-19. Results We identified 41 patients who were E484K mutation negative who shared a hospital room with some of the identified 34 E484K positive patients. Six (14%) underwent repeat COVID-19 testing and remained E484K negative and none developed signs or symptoms of COVID-19 re-infection during the 30 days following exposure. The mortality rate was 7% (3/41) and re-admission rate was zero at 30 days from exposure. Conclusion Despite the small sample size, we did not observe any evidence of re-infection among patients with COVID-19 who shared a hospital room with E484K positive patients during their acute infection. If necessary due to high hospital occupancy, patients with discordant E484K results can be safely cohorted in a shared room. Disclosures All Authors: No reported disclosures

scholarly journals The Symbiotic Mutualism between Co-Creation and Entrepreneurship

2021 ◽  
Vol 13 (11) ◽  
pp. 6285
Author(s):  
Sandra Misiak-Kwit ◽  
Małgorzata Wiścicka-Fernando ◽  
Kelaniyage Shihan Dilruk Fernando
Keyword(s):  
Pilot Study ◽  
Small Sample Size ◽  
Strong Association ◽  
Sampling Technique ◽  
Small Sample ◽  
Entrepreneurial Intentions ◽  
Added Value ◽  
Primary Data ◽  
Exploratory Research ◽  
Symbiotic Mutualism

In this manuscript, the authors aim to explore firstly the association between entrepreneurial mindset and co-creation experience, secondly the association between co-creation experience and entrepreneurial intentions, and thirdly the association between entrepreneurial mindset and entrepreneurial intentions within the sustainability context. In this paper, the authors present the results of the pilot study. Primary data were collected from 500 university students from China, Georgia, Poland, Romania, and Sri Lanka by using a convenient sampling technique, and a literature review was the primary method of the concept development. The authors selected the above-mentioned countries to collect primary data by using a convenient sampling technique based on accessibility; they also visited all analysed countries in order to conduct the pilot survey personally. Descriptive statistics and the Spearman’s rank correlation coefficient were applied as primary statistical methods. The findings reveal that there is a very strong association between co-creation experience and entrepreneurial intentions, a very weak negative association between entrepreneurial mindset and co-creation experience, and, surprisingly, a weak association between entrepreneurial mindset and entrepreneurial intentions. The added value of the conducted pilot research involves filling in a gap regarding the relationship between experience and the subjective norm. In the presented pilot research, co-creation experience was compared with not only entrepreneurial mindset but with entrepreneurial intentions as well. An additional value of this exploratory research is compiling an international comparison. The main contribution of this pilot study is examining the symbiotic mutualism between co-creation and entrepreneurship. Among many platforms of associations, the following can be differentiated: creativity, innovativeness, openness, engagement, awareness, motivation, trust (level of social capital), and recognizing the significance of social and sustainable development objectives. Due to the small sample size, the results cannot be generalised. Results refer only to the respondents. However, the findings of the pilot study are the basis for further research studies on symbiotic mutualism between entrepreneurship and co-creation.

Penumbra Consumption Rates Based on Time-to-Maximum Delay and Reperfusion Status: A Post Hoc Analysis of the DEFUSE 3 Trial

Stroke ◽  
2021 ◽  
Author(s):  
Shadi Yaghi ◽  
Eytan Raz ◽  
Seena Dehkharghani ◽  
Howard Riina ◽  
Ryan McTaggart ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Infarct Volume ◽  
Interquartile Range ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Post Hoc Analysis ◽  
Consumption Rates ◽  
Post Hoc

Background and Purpose: In patients with acute large vessel occlusion, the natural history of penumbral tissue based on perfusion time-to-maximum (T max ) delay is not well established in relation to late-window endovascular thrombectomy. In this study, we sought to evaluate penumbra consumption rates for T max delays in patients with large vessel occlusion evaluated between 6 and 16 hours from last known normal. Methods: This is a post hoc analysis of the DEFUSE 3 trial (The Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke), which included patients with an acute ischemic stroke due to anterior circulation occlusion within 6 to 16 hours of last known normal. The primary outcome is percentage penumbra consumption, defined as (24-hour magnetic resonance imaging infarct volume–baseline core infarct volume)/(T max 6 or 10 s volume–baseline core volume). We stratified the cohort into 4 categories based on treatment modality and Thrombolysis in Cerebral Infarction (TICI score; untreated, TICI 0-2a, TICI 2b, and TICI3) and calculated penumbral consumption rates in each category. Results: We included 141 patients, among whom 68 were untreated. In the untreated versus TICI 3 patients, a median (interquartile range) of 53.7% (21.2%–87.7%) versus 5.3% (1.1%–14.6%) of penumbral tissue was consumed based on T max >6 s ( P <0.001). In the same comparison for T max >10 s, we saw a difference of 165.4% (interquartile range, 56.1%–479.8%) versus 25.7% (interquartile range, 3.2%–72.1%; P <0.001). Significant differences were not demonstrated between untreated and TICI 0-2a patients for penumbral consumption based on T max >6 s ( P =0.52) or T max >10 s ( P =0.92). Conclusions: Among extended window endovascular thrombectomy patients, T max >10-s mismatch volume may comprise large volumes of salvageable tissue, whereas nearly half the T max >6-s mismatch volume may remain viable in untreated patients at 24 hours.

Abstract 3725: Simvastatin but Not Pravastatin Affects Sleep: Findings from the UCSD Statin Study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Beatrice A Golomb ◽  
Edwin K Kwon ◽  
Michael H Criqui ◽  
Joel E Dimsdale
Keyword(s):  
Sleep Quality ◽  
Rating Scale ◽  
Sleep Problems ◽  
Small Sample Size ◽  
Case Reports ◽  
Controlled Trial ◽  
Small Sample ◽  
T Test ◽  
Secondary Outcome ◽  
Regression Analyses

Background : Case reports have suggested possible effects of lipophilic statins on sleep in some subjects. Most randomized studies evaluating the effect of statins on sleep have had small sample size and short duration (≤ 6 weeks). Whether statins affect sleep on average, favorably or adversely, has been unclear. Goal : To assess the effects of lipophilic and hydrophilic statins on sleep. Subjects : 1016 adult men and women without diabetes or heart disease, with LDL-cholesterol 115–190mg/dL. Design : Randomized double blind placebo-controlled trial of simvastatin 20mg, pravastatin 40mg or placebo for 6 months. Sleep was a prespecified secondary outcome. It was assessed by both an adaptation of the Leeds sleep scale (a visual analog scale of sleep quality); and a rating scale of sleep problems. Both items were measured at baseline and on-treatment. Analysis : Baseline comparability of randomization groups including sleep measures was affirmed. T-test of mean on-treatment sleep scores across randomization groups was performed. This complemented regression analyses, adjusted for baseline values of the respective sleep assessment. Results : Groups were comparable at baseline on variables including both sleep measures. Simvastatin use was associated with significantly worse sleep quality, and significantly greater reported sleep problems than either pravastatin or placebo, by t-test and regression analyses. Pravastatin did not differ significantly from placebo on any sleep outcome. Conclusion : Findings were compatible with the hypothesis that statins may impair sleep in some subjects, and that this impairment may arise selectively with lipophilic statins. Table 1. Effects of Statins on Sleep: Regression Analysis

Predictors and impact of hemorrhagic transformations after endovascular thrombectomy in patients with acute large vessel occlusions

2018 ◽  
Vol 11 (5) ◽  
pp. 469-473 ◽  
Author(s):  
Yu Bin Lee ◽  
Woong Yoon ◽  
Yun Young Lee ◽  
Seul Kee Kim ◽  
Byung Hyun Baek ◽  
...  
Keyword(s):  
Lower Risk ◽  
Independent Predictor ◽  
Hemorrhagic Transformation ◽  
Large Vessel ◽  
Regression Analyses ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Poor Outcome ◽  
Male Sex

BackgroundPredictors and impact of hemorrhagic transformation (HT) after thrombectomy remain to be elucidated.ObjectiveTo investigate the independent predictors and impact of each hemorrhagic infarction (HI) and parenchymal hematoma (PH) after thrombectomy in patients with acute stroke due to intracranial large vessel occlusion (LVO).Materials and methodsWe retrospectively reviewed data from 400 patients with acute LVO who underwent thrombectomy. Logistic regression analyses were performed to determine independent predictors of HI and PH on post-treatment CT scans. Associations between HT and poor outcome (modified Rankin Scalescore ≥3) at 90 days were analyzed.ResultsHT was observed in 98 patients (62 HIs (15.5%) and 36 PHs (9%)). Independent predictors of HI were male sex, atrial fibrillation, and time from symptom onset to groin puncture. Hyperlipidemia (OR=0.221, 95% CI 0.064 to 0.767, P=0.017) and successful reperfusion (OR=0.246, 95% CI 0.093 to 0.651, P=0.005) were independently associated with a lower chance of PH, while hypertension (OR=2.260, 95% CI 1.014 to 5.035, P=0.046) and longer procedure duration (OR=1.046, 95% CI 1.016 to 1.077, P=0.003) were independently associated with a higher chance of PH. Only PH (OR=10.154, 95% CI 3.260 to 31.632, P<0.001) was an independent predictor of poor outcome.ConclusionsPH is independently associated with poor outcome, whereas HI does not predict outcome after thrombectomy in patients with acute LVO. Our findings suggest that rapid and successful reperfusion is essential to prevent PH in patients undergoing thrombectomy for acute LVO. In addition, our study suggests that hyperlipidemia is associated with a lower risk of PH in such patients.

scholarly journals Risk factors for acute toxoplasmosis in England and Wales

2016 ◽  
Vol 145 (1) ◽  
pp. 23-29 ◽  
Author(s):  
B. SAID ◽  
K. D. HALSBY ◽  
C. M. O'CONNOR ◽  
J. FRANCIS ◽  
K. HEWITT ◽  
...  
Keyword(s):  
Risk Factors ◽  
Small Sample Size ◽  
Strong Association ◽  
Small Sample ◽  
Vulnerable Groups ◽  
Food History ◽  
England And Wales ◽  
Potential Risk Factors ◽  
Acute Toxoplasmosis ◽  
Control Study

SUMMARYOver 300 cases of acute toxoplasmosis are confirmed by reference testing in England and Wales annually. We conducted a case-control study to identify risk factors for Toxoplasma gondii infection to inform prevention strategies. Twenty-eight cases and 27 seronegative controls participated. We compared their food history and environmental exposures using logistic regression to calculate odds ratios (OR) and 95% confidence intervals in a model controlling for age and sex. Univariable analysis showed that the odds of eating beef (OR 10·7, P < 0·001), poultry (OR 6·4, P = 0·01) or lamb/mutton (OR 4·9, P = 0·01) was higher for cases than controls. After adjustment for potential confounders a strong association between beef and infection remained (OR 5·6, P = 0·01). The small sample size was a significant limitation and larger studies are needed to fully investigate potential risk factors. The study findings emphasize the need to ensure food is thoroughly cooked and handled hygienically, especially for those in vulnerable groups.

scholarly journals Clinical features of Anti-synthetase syndrome associated interstitial lung disease: a retrospective cohort in China

2020 ◽  
Author(s):  
Xi Zhan ◽  
YAN Wei ◽  
WANG Ying ◽  
LI Qing ◽  
SHI Xuhua ◽  
...  
Keyword(s):  
Interstitial Lung Disease ◽  
Lung Disease ◽  
Clinical Features ◽  
Retrospective Cohort ◽  
Small Sample Size ◽  
Inflammatory Myopathy ◽  
Small Sample ◽  
Positive Group ◽  
The Difference

Abstract Background Antisynthetase Syndrome (ASSD) is a chronic autoimmune condition characterized by antibodies directed against an aminoacycl transfer RNA synthetase (ARS) along with a group of clinical features including the classical clinical triad: inflammatory myopathy, arthritis, interstitial lung disease (ILD). ASSD is highly heterogenous due to the different organs involvement, and ILD is the main cause of mortality and function loss, which presents as different patterns when diagnosed. We designed this retrospective cohort to describe the clinical features and disease behavior of the ASSD) associated ILD. Methods Retrospectively collected the data of 108 cases of ASSD associated ILD in Beijing Chaoyang Hospital since 2017.12 to 2019.3. Data including age, gender, physical examination, laboratory test, pulmonary function and High Resolution Computer Tomography (HRCT), treatment, were obtained from the Electronic Medical Record (EMR) system. Patients were divided into 5 groups according to the distinct Aminoacyl tRNA synthetases (ARS) antibodies, and all patients had a multiple discussion team (MDT) to make a radiological and pathological diagnosis of the ILD pattern. Each patient had at least 1 follow up for no less than 6 months. Patients with missing data of MDT evaluation or follow up were excluded. Results: 108 consecutive patients were recruited in this retrospective cohort. 30 cases received bronchoscopy for a transbronchial lung biopsy. 3 had bronchoscopy for a transbronchial cryobiopsy. 33 were with JO-1 positive and 30 were with PL-7 positive. 23 with EJ positive, 13 with PL12 positive and 9 with OJ positive. JO-1 group had a significant higher rate of mechanic’s hand (57.6%) than other 4 groups, the skin involvement (Gottron Papules and/or Heliotrope Rash) was found in 38 (35%) and no difference was found among the 5 groups. Polymyositis/Dermatomyositis (PM/DM) was diagnosed in 25 (23.1%) patients and no difference was observed among the 5 groups. The anti-PL7 positive group had a higher frequency of UIP pattern (13.3%) than other 4 groups but the difference was not significant due to the small sample size, and EJ group had the most frequent OP pattern(78.2%), which was significantly higher than PL-7 group (P<0.001) and PL-12 group (P=0.025). The median follow-up time were 10.7 months. All received prednisone treatment, with or without immunosuppressants ,and at the 6-month-follow up, the JO-1 group and EJ group had the significantly higher improvement of forced vital capacity that the other 3 groups (P<0.05), and PL-7 group had the lowest FVC improvement (P<0.05). The anti-Jo1-positive group and anti-EJ-positive group had significantly higher anti-RO52-positive occurrence than other 3 groups (P<0.05).Conclusion Anti PL-7 antibody had the same frequency as anti-JO1 in ASSD-ILD, in which the ILD pattern was different with distinct anti-ARS antibodies. All ASSD-ILD responded to therapy of steroids, with or without immunosuppressants. PL-7 group had a highest occurrence of UIP pattern, and significantly lower respondence to therapy.

scholarly journals Association of Venous Outflow Profiles and Successful Vessel Reperfusion After Thrombectomy

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000012106
Author(s):  
Tobias Djamsched Faizy ◽  
Reza Kabiri ◽  
Soren Christensen ◽  
Michael Mlynash ◽  
Gabriella Kuraitis ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Tissue Perfusion ◽  
Secondary Outcome ◽  
Multivariable Logistic Regression Analysis ◽  
Venous Outflow ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Cortical Vein ◽  
Good Functional Outcome ◽  
Pre Treatment

Objective:Robust arterial collaterals are associated with successful reperfusion after thrombectomy treatment of acute ischemic stroke due to large vessel occlusion (AIS-LVO). Excellent venous outflow (VO) reflects excellent tissue perfusion and collateral status in AIS-LVO patients. To determine whether favorable VO profiles assessed on pre-treatment CT angiography (CTA) images correlate with successful vessel reperfusion after thrombectomy in AIS-LVO patients.Methods:Multicenter retrospective cohort study of consecutive AIS-LVO patients treated by thrombectomy. Baseline CTA was used to assess collateral status (Tan scale) and VO using the cortical vein opacification score (COVES). Favorable VO was defined as COVES ≥3. Primary outcome was excellent vessel reperfusion status (modified Thrombolysis In Cerebral Infarction [TICI] 2c-3). Secondary outcome was good functional outcome defined as 0-2 on the Modified Ranking Scale (mRS) after 90 days.Results:565 patients met inclusion criteria. Multivariable logistic regression analysis showed that favorable VO (OR= 2.10 [95% CI 1.39-3.16]; p<0.001) was associated with excellent vessel reperfusion during thrombectomy, regardless of good CTA collateral status (OR= 0.87 [95%CI 0.58-1.34]; p=0.48). A favorable VO profile (OR= 8.9 [95%CI 5.3-14.9]; p<0.001) and excellent vessel reperfusion status (OR = 2.7 [95%CI 1.7-4.4]; p<0.001) were independently associated with good functional outcome adjusted for age, sex, glucose, tPA administration, good CTA collateral status and presentation NIHSS.Conclusion:A favorable VO profile is associated with reperfusion success and good functional outcomes in patients with AIS-LVO treated by endovascular thrombectomy.

scholarly journals Lenalidomide Plus Hypomethylating Agent for Acute Myeloid Leukemia (AML) with Recurrent Genetic Abnormalities -AML with Inv(3)(q21.3q26.2) or t(3;3)(q21.3;q26.2); GATA2, Mecom

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4042-4042
Author(s):  
Lauren E. Merz ◽  
Anthony J. Perissinotti ◽  
Bernard Lawrence Marini ◽  
Ashley Crouch ◽  
Kristen Pettit ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
Myeloid Leukemia ◽  
Retrospective Cohort ◽  
Response Rate ◽  
Small Sample Size ◽  
Poor Response ◽  
Small Sample ◽  
University Of Michigan ◽  
Duration Of Response ◽  
The University

Abstract Intro: Acute myeloid leukemia (AML) is a heterogeneous clonal hematopoietic neoplasm. The cytogenetic changes associated with AML impact response rate and survival, and is one of the most important independent prognostic factors. AML with inv(3)(q21.3q26.2) or; GATA2, MECOMaccounts for 1-2% of all forms of AML. This form is associated with a younger age at diagnosis, poor response to standard induction chemotherapy, and very poor long-term prognosis with an overall survival of <10%. Unfortunately, traditional intensive induction chemotherapy has a reported remission rates of 10-20% (Raya et al. Hematology 2015;20(8):435-441). Clearly, alternative chemotherapy approaches are needed to effectively treat AML with inv(3). We previously presented a case report of a patient with inv(3) receiving induction chemotherapy with a combination of a hypomethylating agent (HMA) with lenalidomide and achieving remission (Platzbecker, et al. Leukemia 2013;27:1813-1819, Foucar et al. American Journal of Clinical Pathology2015; 144(1): 6-18). To further address the effectiveness of this regimen, we performed a retrospective cohort study comparing outcomes with HMA plus lenalidomide to standard intensive induction therapies in newly diagnosed and relapsed/refractory AML with inv(3). Methods: We conducted a single-center, IRB-approved, retrospective cohort analysis of 939 patients who received therapy for AML at the University of Michigan between March 2005-June 2018. 15/939 (1.6%) patients tested positive for inv(3)(q21.3q26.2), and they were divided into two cohorts: a lenalidomide-based regimen or other chemotherapy induction approaches. Data abstraction of patient, disease and treatment-related variables was performed through manual chart review. The primary outcome was overall response rate (ORR), reported as the combination of complete remission (CR) and complete remission with incomplete count recovery (CRi). Secondary endpoints included overall survival (OS), 30- and 60-day mortality, event free survival (EFS), and duration of response. All data were analyzed using SPSS software, version 24.0 (SPSS, Inc., Chicago, IL). Results: In total, 15 patients were positive for inv(3)(q21.3q26.2) and underwent treatment at the University of Michigan. 4/16 (25%) received lenalidomide and HMA as primary therapy. Patient demographics and lab values at diagnosis are shown in Table 1. 4/4 (100%) of patients receiving lenalidomide with HMA as first line therapy achieved CR/CRi while 3/11 (27.3%) of patients receiving other chemotherapeutic agents initially achieved CR/CRi (p=0.0256). Duration of response was numerically longer in patients receiving lenalidomide-based therapies (7.4 months vs. 1.45 months; p=0.057). Primary and secondary outcomes in patients receiving lenalidomide plus HMA and other chemotherapies are shown in Table 2. 2/13 patients requiring salvage therapy received lenalidomide with HMA. Both of these patients achieved CR/CRi, while 3/11 (27.3%) of patients receiving other chemotherapy achieved CR/CRi. Combining initial and salvage inductions, 6/6 (100%) achieved CR/CRi with lenalidomide with HMA versus 6/22 (27.3%) with other chemotherapy (p=0.0025). Discussion: AML with inv(3)(q21.3q26.2) or t(3;3)(q21.3;q26.2); GATA2, MECOMis notorious for a poor response to standard induction chemotherapy and a reported remission rate of 10-20% with traditional chemotherapy (Raya et al. Hematology 2015;20(8):435-441).In this cohort, all patients who received lenalidomide with or without a HMA achieved CR/CRi compared to 27% of patients receiving other chemotherapy. Importantly, the median duration of response with lenalidomide and HMA was longer than traditional chemotherapy, although not statistically significant, likely due to the small sample size. The high ORR and reasonable duration of response could allow for potentially curative alloHCT in these high-risk AML patients. Our study is limited by the small sample size due to the rarity of this AML subtype, but the initial data suggests that lenalidomide plus HMA is a promising approach for patients with AML with inv(3)(q21.3q26.2) or t(3;3)(q21.3;q26.2); GATA2, MECOM. A multicenter, prospective trial should be considered to compare the efficacy of traditional cytotoxic chemotherapy approaches versus lenalidomide plus HMA to improve outcomes in this subtype of AML. Disclosures Bixby: GlycoMimetics: Research Funding.

Abstract WP58: Correlating Stroke Volume with National Institute of Health Stroke Scale as a Means of Determining Patient Prognosis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Pamela J Zelnick ◽  
Liang Zhu ◽  
Louise D McCullough ◽  
Amrou Sarraj
Keyword(s):  
Patient Outcomes ◽  
Infarct Volume ◽  
Strong Predictor ◽  
Ratio Test ◽  
Vessel Occlusion ◽  
Good Outcome ◽  
Poor Outcome ◽  
The Poor ◽  
Poor Outcome Group ◽  
Outcome Group

Introduction: The NIH Stroke Scale (SS) is a widely used tool for directing treatment and predicting outcomes in Acute Ischemic Stroke (AIS). Severe strokes with high admission SS often correlate with long term disability, and as such, SS serves as a strong predictor of outcome. Final infarct volume (FIV) is also a pivotal predictor of stroke outcome. We aimed to evaluate the relationship between SS, FIV and outcome, and hypothesize that a combined approach evaluating both FIV and SS may more accurately correlate with patient outcomes. Methods: A single center, retrospective cohort study, examined AIS patients with large vessel occlusion (LVO) affecting the anterior circulation, between July 2004 and April 2013. Patients were stratified by treatment to 1) intra-arterial therapy, 2) IV tPA, 3) both or 4) neither. Primary outcomes measured were mRS at discharge and 90 days (good outcome mRS 0-2, poor 4-6). FIV was manually calculated from DWI obtained within the first 7 days of presentation. SS and FIV were compared against good and poor mRS outcomes using Wilcoxon rank sum test. Logistic regression analysis was used to evaluate the association between SS, FIV and mRS. Finally, likelihood ratio test was used to compare model fit between a model including SS alone and model including both SS and FIV. Results: In 332 patients, SS was significantly higher in the poor outcome group (17.3 ± 5.4) when compared to the good outcome group (13.0 ± 6.1) (p=0.0002). In the same analysis, FIVs were also larger in the poor outcome group (110.3 ± 113 cm3) when compared to the good outcome group (37.2 ± 68.3 cm3) (p<0.0001). A combined SS and FIV model correlated significantly better with discharge outcome than did SS alone (p=0.0015). Analysis of 182 patient outcomes at 90 days maintained similar findings, with SS (18 ± 5.9) and FIVs (115.4 ± 121.0 cm3) significantly higher in poor outcomes than in good outcomes; (13.0 ± 5.4) and (35.7 ± 38.2 cm3) respectively (p<0.0001). Combined SS and FIV model, again, was significantly better at modeling outcome at 90 days than was a model including SS alone (p=0.0044). Conclusions: A combined model including FIV and SS better correlates with clinical outcomes at discharge and 90 days in patients with AIS due to LVO, than does a model using SS alone.

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