Endovascular Therapy for Acute Ischemic Stroke of Intracranial Atherosclerotic Origin—Neuroimaging Perspectives

Large vessel occlusion (LVO) due to intracranial atherosclerosis (ICAS) is a common cause of acute ischemic stroke (AIS) in Asians. Endovascular therapy (EVT) has been established as the mainstay of treatment in patients with AIS and LVO. However, only a few patients of Asian descent with ICAS-related LVO (ICAS-LVO) were included in recent randomized controlled trials of EVT for AIS. Therefore, the findings of these trials cannot be directly applied to Asian patients with ICAS-LVO. In embolic LVO due to thrombus from the heart or a more proximal vessel, rapid, and complete recanalization can be achieved in more than 70–80% of patients, and it is important to exclude patients with large cores. In contrast, patients with ICAS-LVO usually have favorable hemodynamic profiles (good collateral status, small core, and less severe perfusion deficit), but poor response to EVT (more rescue treatments and longer procedure times are required for successful recanalization due to higher rates of reocclusion). Patients with ICAS-LVO may have different anatomic (plaque, angioarchitecture), hemodynamic (collateral status), and pathophysiologic (thrombus composition) features on neuroimaging compared to patients with embolic LVO. In this review, we discuss these neuroimaging features, their clinical implications with respect to determination of EVT responses, and the need for development of specific EVT devices and procedures for patients with ICAS-LVO

Multimodal MRI-Based Triage for Acute Stroke Therapy: Challenges and Progress

Revascularization therapies have been established as the treatment mainstay for acute ischemic stroke. However, a substantial number of patients are either ineligible for revascularization therapy, or the treatment fails or is futile. At present, non-contrast computed tomography is the first-line neuroimaging modality for patients with acute stroke. The use of magnetic resonance imaging (MRI) to predict the response to early revascularization therapy and to identify patients for delayed treatment is desirable. MRI could provide information on stroke pathophysiologies, including the ischemic core, perfusion, collaterals, clot, and blood–brain barrier status. During the past 20 years, there have been significant advances in neuroimaging as well as in revascularization strategies for treating patients with acute ischemic stroke. In this review, we discuss the role of MRI and post-processing, including machine-learning techniques, and recent advances in MRI-based triage for revascularization therapies in acute ischemic stroke

The Long-Term Effect of Cancer on Incident Stroke: A Nationwide Population-Based Cohort Study in Korea

Background and Purpose: Despite the recent growing interest in the cancer–stroke association, the long-term effect, and organ-specific association with stroke incidence in subjects with cancer have not been clearly defined.Methods: Data were obtained from the Korean National Health Insurance Service National Sample Cohort database between 2002 and 2015. To investigate the effects of cancer on stroke incidence, subjects were classified into cancer and non-cancer groups based on the period after cancer diagnosis and origin organ of cancer. To minimize the effects of selection bias, we performed a propensity score matching analysis with covariates of demographic data, vascular risk factors, antithrombotics use and statin use. Incident stroke was diagnosed based on operational definition and classified into ischemic stroke and hemorrhagic stroke.Results: Data of 20,707 subjects with cancer and 675,594 without cancer were analyzed for 7 follow-up years. The subjects with cancer had higher risk of any stroke (subdistribution hazard ratio [SHR], 1.13; 95% confidence interval [CI], 1.02–1.26; p = 0.0181) than those without cancer. Similar trend was found for ischemic stroke (SHR, 1.17; 95% CI, 1.05–1.31; p = 0.0054), but not for hemorrhagic stroke. The risk of stroke was increased in subjects with cancer in the digestive organ, respiratory and intrathoracic organ, and “others (such as breast and female and male reproductive organs)” in 3 years; however, the association disappeared thereafter except those with “others” cancer. Chemotherapy increased the risk of ischemic stroke (SHR 1.21; 95% CI, 1.03–1.41).Conclusions: Cancer increases the risk of stroke at 3 years after the diagnosis of cancer, and the effect was maintained for 7 years. The association between cancer and stroke incidence depends on the organ from which the cancer originated and chemotherapy

Abnormal spatial heterogeneity governing the charge-carrier mechanism in efficient Ruddlesden-Popper perovskite solar cells

Layered Ruddlesden-Popper perovskite (RPP) photovoltaics have gained substantial attention owing to their excellent air stability. However, their photovoltaic performance is still limited by the unclear real-time charge-carrier mechanism of operating devices. Herein, we report the correlation between the charge-carrier mechanism and the spatially heterogeneous RPP bulks induced by distinct sublattice cations in the state-of-the-art antisolvent-driven RPP devices. In particular, abnormal heterogeneities ranging from the lateral long-range to local sub-grain scale and corresponding charge-carrier behaviours are visualized for triple-cation RPPs. We discovered that such heterogeneities with a unitary 2D/3D hybrid suppress lattice vibrations and reduce Frohlich interactions by about 2 times, significantly promoting charge-carrier dynamics. Consequently, optimized triple-cation RPP solar cells greatly outperform their mono-cation counterparts. Furthermore, this principle can be applicable irrespective of 2D layer thickness (n > 2) and substrate type. This work provides a rationale for leveraging a disordered structure to stimulate charge-carrier motion and suggests the design principle of low-dimensional perovskites.

Severe Pulmonary Adverse Effects in Lymphoma Patients Treated with Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (CHOP) Regimen Plus Rituximab

BACKGROUND/AIMS: The aim of our study was to determine the incidence and clinical features of severe pulmonary complications in patients receiving cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or rituximab plus CHOP (R-CHOP) as the initial treatment for lymphoma. METHODS: A retrospective analysis of pulmonary infection and drug-induced interstitial pneumonitis (DIIP) was performed using lymphoma registry data. R-CHOP was administered in 71 patients and CHOP in 29 patients. RESULTS: The severe pulmonary adverse events tended to occur more frequently with R-CHOP (18.3%) than CHOP alone (13.8%), although the difference was not significant (p = 0.771). DIIP occurred in five patients in the R-CHOP arm (7%) and in one in the CHOP arm (3%). The continuous use of steroids for conditions other than lymphoma significantly increased the risk of pulmonary infection including Pneumocystis jiroveci pneumonia (p = 0.036) in the multivariate analysis. International prognostic index, tumor stage, smoking, previous tuberculosis, chronic obstructive pulmonary disease, and lymphoma involvement of lung parenchyma were not related to pulmonary adverse events. Patients who experienced severe pulmonary events showed shorter survival when compared to those without complications (p = 0.002). CONCLUSIONS: Our experiences with serial cases with DIIP during chemotherapy and the correlation of continuous steroid use with pulmonary infection suggest that the incidence of pulmonary complications might be high during lymphoma treatment, and careful monitoring should be performed.ope

Molecular Modeling Study for Interaction between Bacillus subtilis Obg and Nucleotides

The bacterial Obg proteins (Spo0B-associated GTP-binding protein) belong to the subfamily of P-loop GTPase proteins that contain two equally and highly conserved domains, a C-terminal GTP binding domain and an N-terminal glycine-rich domain which is referred as the “Obg fold” and now it is considered as one of the new targets for antibacterial drug. When the Obg protein is associated with GTP, it becomes activated, because conformation of Obg fold changes due to the structural changes of GTPase switch elements in GTP binding site. In order to investigate the effects and structural changes in GTP bound to Obg and GTPase switch elements for activation, four different molecular dynamics (MD) simulations were performed with/without the three different nucleotides (GTP, GDP, and GDP + Pi) using the Bacillus subtilis Obg (BsObg) structure. The protein structures generated from the four different systems were compared using their representative structures. The pattern of Cα-Cα distance plot and angle between the two Obg fold domains of simulated apo form and each system (GTP, GDP, and GDP+Pi) were significantly different in the GTP-bound system from the others. The switch 2 element was significantly changed in GTP-bound system. Also root-mean-square fluctuation (RMSF) analysis revealed that the flexibility of the switch 2 element region was much higher than the others. This was caused by the characteristic binding mode of the nucleotides. When GTP was bound to Obg, its γ-phosphate oxygen was found to interact with the key residue (D212) of the switch 2 element, on the contrary there was no such interaction found in other systems. Based on the results, we were able to predict the possible binding conformation of the activated form of Obg with L13, which is essential for the assembly with ribosome

Analysis of shots on target and goals scored in soccer matches: Implications for coaching and training goalkeepers

The aim of this study was to analyse the characteristics and patterns of shots on target and goals scored  during the 2012-European Championship. The broadcasted matches were recorded and converted into  electronic video files for a computerbased analysis. This quantitative study examined 31 matches of the  championship and identified 123 shots on target (which were not goals) and 73 goals scored. The results  revealed that 88 (72%) shots on target and 39 (53.4%) goals scored were aimed at the low zones of the  goalposts. Goalkeepers blocked 80 shootings (65%) from outside of the penalty area, whilst 65 goals (89%) were scored inside the penalty area. Based on the low zones of the goalposts and shooting angles, 72 shots on target and goals scored were from different angles and 55 were from the same angles. There was a significant difference (χ2=20.61; p<0.001) between the 26 goals from different angles and the 13 goals from the same  angles in the low zones of the goalposts. Methodical training programmes for low-flying balls, body  movements, decision-making and cooperative defence strategies were recommended for goalkeeper training.Key words: Soccer; 2012-European Championship; Match analysis; Goalkeeper training

Prognostic Value of Preoperative Systemic Inflammatory Parameters in Advanced Gastric Cancer

Background: The predictive value of various systemic inflammatory parameters has been reported. However, it is still unclear which inflammatory parameters are the best predictors of prognosis in advanced gastric cancer and what are their mechanisms of action. The aim of this study was to evaluate the association between preoperative systemic inflammatory parameters and overall survival (OS) in patients with advanced gastric cancer. Methods: This retrospective study included 489 patients with stage II/III advanced gastric cancer treated at the National Cancer Center, Republic of Korea, between January 2012 and December 2015. We divided the patients into survivors and non-survivors and compared their clinicopathological characteristics. Univariate and multivariate analyses using the Cox proportional hazards model were performed to evaluate the prognostic value of inflammatory parameters. Results: The absolute lymphocyte count was significantly higher in survivors (2.07 ± 0.62 × 103/µL vs. 1.88 ± 0.63 × 103/µL, p = 0.001). The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) were marginally lower in survivors. Survival analysis revealed that the NLR and PLR were independent prognostic factors for OS. Survival was significantly different depending on NLR and PLR in the same pathologic stages. Conclusions: NLR and PLR were independent prognostic factors for OS in patients with advanced gastric cancer. Regarding single inflammatory parameters, an elevated lymphocyte count was the only factor associated with a favorable prognosis. These results suggest that the enhanced immune function of patients affects their prognosis more than the increased systemic inflammatory response

Electromagnetic and Mechanical Analysis and Measurements of Interior Permanent Magnet Motors Based on Equivalent Magnetic Circuit Method

This paper is about the magnetic field analysis of an interior permanent magnet motor (IPM motor) by using the equivalent magnetic circuit method (EMC method), which requires a small amount of computation time compared with the finite element method (FEM). IPM motors have a specific shape of rotor in which the permanent magnets are embedded. Therefore, in the bridge region, the magnetic saturation is generated due to the shape of the permanent magnet, which affects the magnetic flux density distribution in the air gap and the characteristics of the IPM motor. Thus, to design an IPM motor, the magnetic saturation effects should be considered along with the rotor shape. In addition, because the rotor of the IPM rotates at a high speed directly in connection with the load, the stress generated from the rotor must be stably distributed. Consequently, according to the rotor shape characteristics of the IPM, the stress is concentrated in the thin bridge region during high-speed rotation. When the stress generated in the bridge region exceeds the yield stress of the rotor iron core material, the bridge part is destroyed. Therefore, it is important to analyze the stress that occurs in the rotor during high-speed rotation in the rotor design stage of the IPM. In this study, we analyzed the magnetic field characteristics of an IPM motor using its equivalent magnetic circuit while considering the magnetic saturation in the bridge region. The stability of the rotor was determined by presenting a safety factor based on the maximum stress generated at the rotor for each speed. We derived the stator natural frequency to evaluate the resonance possibility between the electrical frequency and the stator natural frequency. Finally, the validity of the constructed equivalent magnetic circuit was verified by comparing the results with those obtained via the FEM analysis and experiments