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Background: Glycated albumin (GA) is an indicator of glycemic variability over the past 2–4 weeks and has suitable characteristics for predicting the prognosis of ischemic stroke during the acute phase. This study evaluated the association between early neurological deterioration (END) and GA values in patients with acute ischemic stroke (AIS). Methods: We assessed consecutive patients with AIS between 2022 and 2023 at two large medical centers in Korea. END was defined as an increase of ≥ 2 in the total National Institutes of Health Stroke Scale (NIHSS) score or ≥ 1 in the motor NIHSS score within the first 72 h of admission. We evaluated various glycemic parameters including fasting glucose (mg/dL), hemoglobin A1c (%), and GA (%). Results: In total, 531 patients with AIS were evaluated (median age: 69 years, male sex: 66.3%). In the multivariable logistic regression analysis, GA value was positively associated with END (adjusted odds ratio [aOR] = 3.24, 95% confidence interval [CI]: 1.10–9.50). Initial NIHSS score (aOR = 1.04, 95% CI: 1.01–1.08) and thrombolytic therapy (aOR = 2.06, 95% CI: 1.14–3.73) were also associated with END. In a comparison of the predictive power of glycemic parameters for END, GA showed a higher area under the curve value on the receiver operating characteristic curve than fasting glucose and hemoglobin A1c. Conclusions: High GA values were associated with END in patients with AIS. Furthermore, GA was a better predictor of END than fasting glucose or hemoglobin A1c. [ABSTRACT FROM AUTHOR]

Background: Although widely used in clinical fields, real-world data on the role of warfarin and non-vitamin K oral anticoagulants (NOACs) for the secondary prevention of thromboembolic complications in ischemic stroke patients with nonvalvular atrial fibrillation (NVAF) are scarce. Aims: This retrospective cohort study compared the effectiveness and safety of secondary prevention of NOAC and warfarin in ischemic stroke patients with NVAF. Methods: From the Korean National Health Insurance Service Database, we included 16,762 oral anticoagulants-naive acute ischemic stroke patients with NVAF between July 2016 and June 2019. The main outcomes included ischemic stroke, systemic embolism, major bleeding, and all-cause of death. Results: In total, 1717 warfarin and 15,025 NOAC users were included in the analysis. After 1:8 propensity score matching, during the observation period, all types of NOACs had a significantly lower risk of ischemic stroke and systemic embolism than warfarin (edoxaban: adjusted hazard ratio [aHR], 0.80; 95% confidence interval [CI], 0.68–0.93, rivaroxaban: aHR, 0.82; 95% CI, 0.70–0.96, apixaban: aHR, 0.79; 95% CI, 0.69–0.91, and dabigatran: aHR, 0.82; 95% CI, 0.69–0.97). Edoxaban (aHR, 0.77; 95% CI, 0.62–0.96), apixaban (aHR, 0.73; 95% CI, 0.60–0.90), and dabigatran (aHR, 0.66; 95% CI, 0.51–0.86) had lower risks of major bleeding and all-cause of death. Conclusions: All NOACs were more effective than warfarin in the secondary prevention of thromboembolic complications in ischemic stroke patients with NVAF. Except for rivaroxaban, most NOACs demonstrated a lower risk of major bleeding and all-cause of death than warfarin. [ABSTRACT FROM AUTHOR]

Background: In ischemic stroke patients with active cancer, cryptogenic stroke has worse prognosis than stroke by conventional mechanisms. However, the individual effects of intracranial atherosclerosis (ICAS) or atrial fibrillation (AF) on the prognosis of these patients have not been studied. Aims: Therefore, we aimed to investigate the effects of ICAS and AF on the prognosis of ischemic stroke patients with active cancer. Methods: We included ischemic stroke patients with active cancer between 2010 and 2020. Early neurological deterioration (END) was defined as an increase of ≥ 1 in the motor NIHSS score, or ≥ 2 in the total NIHSS score within 72 hours of admission. Unfavorable outcomes were defined as a score of ≥ 3 on the 3-month modified Rankin Scale. Results: In total, 116 ischemic stroke patients with active cancer were evaluated. In multivariable analysis, ICAS was positively associated with END (adjusted odds ratio [aOR] = 4.56, 95% confidence interval [CI]: 1.52–13.70), and this association showed a quantitative relationship according to the degree of stenosis of ICAS (stenosis group: aOR = 4.24, 95% CI: 1.31–13.72; occlusion group, aOR = 5.74, 95% CI: 1.05–31.30). ICAS was also closely related to unfavorable outcomes (aOR = 6.33, 95% CI: 1.15–34.79). In contrast, AF showed no significant association with END or unfavorable outcomes. Our data showed that patients with ICAS had larger and more severe initial stroke lesions, and poorer prognosis than those without. Conclusions: ICAS, but not AF, was closely associated with poor prognosis in ischemic stroke patients with active cancer. [ABSTRACT FROM AUTHOR]

Cerebral small vessel diseases (cSVDs) affect the prognosis of various types of ischemic stroke. Therefore, we evaluated the association between cSVD and the prognosis of cryptogenic stroke patients with active cancer. We enrolled patients diagnosed with cryptogenic stroke and active cancer from 2010 to 2016. Early neurological deterioration (END) was defined as a ≥ 2-point increase in the total NIHSS score or a ≥ 1-point increase in the motor NIHSS score within the first 72 h. We defined an unfavorable outcome as the modified Rankin Scale (mRS) score ≥ 3 points. We analyzed cSVD separately for each subtype including white matter hyperintensity (WMH), silent brain infarct (SBI), and cerebral microbleed (CMB). A total of 179 cryptogenic stroke patients with active cancer were evaluated. In the multivariable analysis, SBI was significantly associated with END (adjusted odds ratio = 3.97, 95% confidence interval: 1.53–10.33). This close relationship between SBI and END increased proportionally with an increase in SBI burden. However, WMH and CMB showed no significant association with END. None of the cSVD subtypes showed a statistically significant relationship with the 3-month unfavorable outcome. SBI was the only parameter closely associated with END in cryptogenic stroke patients with active cancer. [ABSTRACT FROM AUTHOR]

Uterine carcinosarcoma is a rare uterine tumour with extremely poor prognosis and a high recurrence rate. Primary treatment for uterine carcinosarcoma is total hysterectomy and bilateral salpingo-oophorectomy, with or without lymph node dissection. Discussion A uterine carcinosarcoma is a rare, highly aggressive, rapidly progressing neoplasm associated with poor prognosis (Kanthan and Senger [5]). Recurrent or metastatic uterine carcinosarcoma are usually treated with surgery, chemotherapy, or radiotherapy. [Extracted from the article]

Background: Although there is a standard guideline for performing revascularization surgery in patients with Moyamoya diseases (MMD), more objective and easily obtainable predictors are still needed. Objectives: In this study, we aimed to evaluate the relationship between an ipsilateral ivy sign and ischemic stroke recurrence in adult MMD patients without revascularization surgery. Methods: We included consecutive MMD patients without revascularization surgery between 2006 and 2014. The ivy sign was defined as a linear or focal high-signal intensity on fluid-attenuated inversion recovery images, and the burdens of ivy sign were rated in each hemisphere. The ischemic stroke recurrence was defined as a new clinical event that accompanied a new brain lesion on magnetic resonance imaging. Results: Overall, 84 patients with 154 hemispheres were analyzed. We found recurrent ischemic stroke in 9 (6%) hemispheres within 3 years. In multivariate analysis, an ipsilateral ivy sign remained an independent predictor of 3-year ischemic recurrence (adjusted hazard ratio [aHR] 10.15, 95% CI 2.10–49.14, p = 0.004). An initial presentation as infarction was also significant (aHR 7.15, 95% CI 1.36–36.78, p = 0.019). The burdens of ivy sign showed a dose-response tendency with the 3-year ischemic recurrence rate (p < 0.001). When comparing the ischemic recurrence rate among 4 groups with and without ivy sign and perfusion defect, the "Ivy sign (+) Perfusion defect (+) group" showed a significantly higher risk in both observed (p = 0.005) and estimated (p = 0.003) 3-year ischemic recurrence than did the other group. Additionally, the "Ivy sign (+) Perfusion defect (–) group" showed a higher recurrence rate than did the "Ivy sign (–) Perfusion defect (+) group". Conclusions: The ivy sign is associated with ischemic recurrence in adult MMD patients in a dose-response manner. It would be helpful for selecting high-risk patients who need revascularization surgery. [ABSTRACT FROM AUTHOR]

Backgrounds: Various studies have reported that the neutrophil-to-lymphocyte ratio in the serum (sNLR) may serve as a cost-effective and useful prognostic factor in patients with various cancer types. However, no study has reported the prognostic impact of the NLR in malignant pleural effusion (MPE). To address this gap, we investigated the clinical impact of NLR as a prognostic factor in MPE (mNLR) and a new scoring system that use NLRs in the serum and MPE (smNLR score) in lung cancer patients.Methods: We retrospectively reviewed all of the patients who were diagnosed with lung cancer and who presented with pleural effusion. To maintain the quality of the study, only patients with malignant cells in the pleural fluid or tissue were included. The patients were classified into three smNLR score groups, and clinical variables were investigated for their correlation with survival.Results: In all, 158 patients were classified into three smNLR score groups as follows: 84 (53.2%) had a score of 0, 58 (36.7%) had a score of 1, and 16 (10.1%) had a score of 2. In a univariate analysis, high sNLR, mNLR, and increments of the smNLR score were associated with shorter overall survival (p < 0.001, p = 0.004, and p < 0.001, respectively); moreover, age, Eastern Cooperative Oncology Group performance status (ECOG PS), histology, M stage, hemoglobin level, albumin level, and calcium level were significant prognostic factors. A multivariable analysis confirmed that ECOG PS (p < 0.001), histology (p = 0.001), and smNLR score (p < 0.012) were independent predictors of overall survival.Conclusions: The new smNLR score is a useful and cost-effective prognostic factor in lung cancer patients with MPE. Although further studies are required to generalize our results, this information will benefit clinicians and patients in determining the most appropriate therapy for patients with MPE. [ABSTRACT FROM AUTHOR]

Objective: Pontine infarction is a common type of brain stem infarction and early neurological deterioration (END). We evaluated the possibility of severe white matter hyperintensity (WMH) as a predictor of END in isolated pontine infarction. Methods: We recruited 2 types of patients with isolated pontine infarction within 24 h from symptom onset. END was defined as an increase of ≥ point on the motor National Institutes of Health Stroke Scale (NIHSS) or ≥2 points on the total NIHSS score within 72 h from admission. We graded WMH using Fazekas scale, which is dichotomized into mild (grades 0-1) and moderate to severe (grades 2-3) on fluid-attenuated inversion recovery images. Results: A total of 82 patients with an isolated pontine infarction were selected. END was detected in 23 patients (28%). Severe periventricular and subcortical WMH (PVWMH and SCWMH, respectively) were more frequent in deteriorating patients (p = 0.001 and p = 0.019, respectively). A logistic regression analysis revealed that both severe PVWMH (OR 6.17; 95% CI 1.93-19.75, p = 0.002) and SCWMH (OR 3.19; 95% CI 1.10-9.23, p = 0.032) remained independent predictors of END. Conclusions: Both severe PVWMH and SCWMH were useful to predict END in patients with isolated pontine infarction. [ABSTRACT FROM AUTHOR]

Objective. To propose a measure of anemia to be used as a prognostic factor for progression-free survival and overall survival in advanced epithelial ovarian cancer patients. Patients and Methods. Seventy-six patients with International Federation of Gynecology and Obstetrics stage III and stage IV epithelial ovarian cancer who had received at least six courses of platinum- and taxane-based systemic chemotherapy and achieved clinical or pathologic complete response were included. A novel prognostic factor based on the duration of anemia was proposed and the impact of anemia on progression-free and overall survival times was analyzed by a log-rank test and a Cox proportional hazards model. Results. We introduce a binary variable, Hb1020, that takes a value of 1 if the duration of a hemoglobin (Hb) level <10 g/dL is &ge:20% of the total duration of chemotherapy. We propose Hb1020 as a potential prognostic factor for epithelial ovarian cancer. The 5-year progression- free survival rates were 48.4% in the Hb1020 = 0 group (duration of Hb <10 g/dL <20% of total duration) and 17.7% in the Hb1020 = 1 group (p = .026). The 5-year overall survival rates were 64.6% and 45.0%, respectively (p = .015). Conclusions. Hb1020, based on the duration of anemia, is a potential prognostic factor for epithelial ovarian cancer. Using Hb1020, we will be able to administer highly optimized treatment for anemia to improve patient survival. Further independent studies are needed to confirm its prognostic role. [ABSTRACT FROM AUTHOR]

Background: The annual risk of stroke or cardiovascular events has been reported to be over 10% in middle cerebral artery stenosis. However, the prognosis of patients with middle cerebral artery occlusion (MCAO) remains unclear. We investigated the risk of cardiovascular events or death in patients with symptomatic or asymptomatic MCAO. Methods: Consecutive patients with MCAO demonstrated by transcranial Doppler sonography and magnetic resonance angiography were enrolled. Medical records were reviewed during the follow-up period and a telephone interview was conducted using a preformed questionnaire, comparing asymptomatic and symptomatic patients who had a history of ischemic stroke or transient ischemic attack in the same vascular territory. The composite outcome of ipsilateral stroke, hemorrhagic stroke, overall stroke, myocardial infarction (MI), any vascular death and nonvascular death was evaluated during the follow-up period. Results: Thirty-seven of the 48 patients were symptomatic and 11 were asymptomatic. During the mean follow-up period of 2.8 years, cardiovascular events or death occurred in a total of 13 patients: 1 from the asymptomatic group and 12 from the symptomatic group (overall stroke, 6; MI, 2; vascular death, 1; nonvascular death, 5). The annual rates of composite outcome (2.2 vs. 13.2%, p = 0.041) and overall stroke (0.0 vs. 6.6%, p = 0.048) were significantly lower in the asymptomatic group. Conclusion: These results suggest that the overall prognosis of MCAO is not worse than previously reported for patients with middle cerebral artery stenosis or internal carotid artery stenosis. Asymptomatic MCAO seems to be a benign condition associated with a low risk of subsequent stroke, MI or death under the optimal medical therapy. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

We determined whether the severity of sleep apnea increases the risk of mortality in patients with multiple system atrophy (MSA) with and without stridor. MethodsThis retrospective study included patients who underwent polysomnography within one year after diagnosis of probable MSA. Stridor, sleep apnea, and arousal from sleep were determined using full-night polysomnography. Disease severity was measured using the Unified MSA Rating Scale (UMSARS). Survival data were collected and analyzed using Cox regression analysis. Sixty-four patients with MSA were included. During a median follow-up of 34.5 months, 49 (76.6 %) patients died. Stridor was present in 56.3 % of patients. Patients with stridor had more severe sleep apnea and shorter sleep time than those without, but the hazard ratio (HR) for death did not differ between patients with and without stridor. Among patients without stridor, apnea-hypopnea index ≥30/h (HR, 6.850; 95 % confidence interval [CI], 1.983–23.664; p = 0.002) and a score of UMSARS I + II (HR, 1.080; 95 % CI, 1.040–1.121; p < 0.001) were independently associated with death. In contrast, among patients with stridor, frequent arousals from sleep (HR, 0.254; 95 % CI, 0.089–0.729; p = 0.011) were a significant factor associated with longer survival, while MSA-cerebellar type tended to be associated with poor survival (HR, 2.195; 95 % CI, 0.941–5.120; p = 0.069). The severity of sleep apnea might be a significant predictor of shorter survival in MSA patients without stridor, whereas frequent arousals from sleep might be a significant predictor for longer survival in MSA patients with stridor. • Nocturnal stridor was present in 56.3 % of patients with multiple system atrophy (MSA). • The risk for mortality did not differ between MSA patients with and without stridor. • Severity of sleep apnea was related to shorter survival in patients without stridor. • Frequent arousals from sleep were associated with longer survival in patients with stridor. [ABSTRACT FROM AUTHOR]