This cohort study assesses secular changes in initial neurological severity and short-term functional outcomes of patients with acute stroke by sex using a large population.

Our results show that transapical aortic cannulation is safe and useful for repair of type A aortic dissection. There are advantages to transapical aortic cannulation, such as simple and quick cannulation technique, sufficient antegrade aortic flow, and the reliability of true lumen perfusion with decreased risk of stroke and malperfusion.

BackgroundThe purpose of this study was to examine the relationships between glucose parameters obtained by continuous glucose monitoring and clinical outcomes in acute stroke patients.Methods and ResultsConsecutive patients with acute ischemic stroke or intracerebral hemorrhage within 24 hours after onset were included. A continuous glucose monitoring device (iPro2) was attached for the initial 72 hours after emergent admission. Eight glucose parameters were obtained from continuous glucose monitoring: maximum, minimum, mean, and SD of blood glucose levels, as well as area under the curve more than 8 mmol/L of blood glucose, distribution time more than 8 mmol/L of blood glucose, coefficient of variation (%CV), and presence of time less than 4 mmol/L over 72 hours. The primary outcome measure was death or dependency at 3 months (modified Rankin Scale score ≥3). One hundred patients with acute ischemic stroke (n=58) or intracerebral hemorrhage (n=42) were included. Blood glucose levels varied between 5.2±1.4 and 11.4±3.2 mmol/L over 72 hours, with area under the curve more than 8 mmol/L of blood glucose of 0.7±1.4 min×mmol/L, distribution time more than 8 mmol/L of blood glucose of 31.7±32.7%, coefficient of variation of 15.5±5.4%, and presence of hypoglycemia in 20% of overall patients. Mean glucose level (adjusted odds ratio, 1.60, 95% confidence interval, 1.12–2.28/1 mmol/L), area under the curve more than 8 mmol/L of blood glucose (2.13, 1.12–4.02/1 min×mmol/L), and distribution time more than 8 mmol/L of blood glucose (1.25, 1.05–1.50/10%) were related to death or dependency for overall patients, as well as for acute ischemic stroke patients (2.05, 1.15–3.65; 2.38, 1.04–5.44; 1.85, 1.10–3.10, respectively).ConclusionsHigh mean glucose levels, distribution time more than 8 mmol/L of blood glucose, and areas under the curve more than 8 mmol/L of blood glucose during the initial 72 hours of acute stroke were associated with death or dependency at 3 months.

Size and density measurements of objects undertaken using computed tomography (CT) are clinically significant for diagnosis. To evaluate the accuracy of these quantifications, we simulated three-dimensional (3D) CT image blurring; this involved the calculation of the convolution of the 3D object function with the measured 3D point spread function (PSF). We initially validated the simulation technique by performing a phantom experiment. Blurred computed images showed good 3D agreement with measured images of the phantom. We used this technique to compute the 3D blurred images from the object functions, in which functions are determined to have the shape of an ideal sphere of varying diameter and assume solitary pulmonary nodules with a uniform density. The accuracy of diameter and density measurements was determined. We conclude that the proposed simulation technique enables us to estimate the image blurring precisely of any 3D structure and to analyze clinical images quantitatively.

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The measurement of modulation transfer functions (MTFs) in computed tomography (CT) is often performed by scanning a point source phantom such as a thin wire or a microbead. In these methods the region of interest (ROI) is generally placed on the scanned image to crop the point source response. The aim of the present study was to examine the effect of ROI size on MTF measurement, and to optimize the ROI size. Using a 4 multidetector‐row CT, MTFs were measured by the wire and bead methods for three types of reconstruction kernels designated as ‘smooth', ‘standard', and ‘edge‐enhancement’ kernels. The size of a square ROI was changed from 30 to 50 pixels (approximately 2.9 to 4.9 mm). The accuracies of the MTFs were evaluated using the verification method. The MTFs measured by the wire and bead methods were dependent on ROI size, particularly in MTF measurement for the ‘edge‐enhancement’ kernel. MTF accuracy evaluated by the verification method changed with ROI size, and we were able to determine the optimum ROI size for each method (wire/bead) and for each kernel. Using these optimal ROI sizes, the MTF obtained by the wire method was in strong agreement with the MTF obtained by the bead method in each kernel. Our data demonstrate that the difficulties in obtaining accurate MTFs for some kernels such as edge‐enhancement can be overcome by incorporating the verification method into the wire and bead methods, allowing optimization of the ROI size to accurately determine the MTF.PACS numbers: 87.57.‐s, 87.57.cf, 87.57.Q‐

ImportanceInternational guidelines recommend avoiding intravenous thrombolysis (IVT) in patients with ischemic stroke who have a recent intake of a direct oral anticoagulant (DOAC).ObjectiveTo determine the risk of symptomatic intracranial hemorrhage (sICH) associated with use of IVT in patients with recent DOAC ingestion.Design, Setting, and ParticipantsThis international, multicenter, retrospective cohort study included 64 primary and comprehensive stroke centers across Europe, Asia, Australia, and New Zealand. Consecutive adult patients with ischemic stroke who received IVT (both with and without thrombectomy) were included. Patients whose last known DOAC ingestion was more than 48 hours before stroke onset were excluded. A total of 832 patients with recent DOAC use were compared with 32 375 controls without recent DOAC use. Data were collected from January 2008 to December 2021.ExposuresPrior DOAC therapy (confirmed last ingestion within 48 hours prior to IVT) compared with no prior oral anticoagulation.Main Outcomes and MeasuresThe main outcome was sICH within 36 hours after IVT, defined as worsening of at least 4 points on the National Institutes of Health Stroke Scale and attributed to radiologically evident intracranial hemorrhage. Outcomes were compared according to different selection strategies (DOAC-level measurements, DOAC reversal treatment, IVT with neither DOAC-level measurement nor idarucizumab). The association of sICH with DOAC plasma levels and very recent ingestions was explored in sensitivity analyses.ResultsOf 33 207 included patients, 14 458 (43.5%) were female, and the median (IQR) age was 73 (62-80) years. The median (IQR) National Institutes of Health Stroke Scale score was 9 (5-16). Of the 832 patients taking DOAC, 252 (30.3%) received DOAC reversal before IVT (all idarucizumab), 225 (27.0%) had DOAC-level measurements, and 355 (42.7%) received IVT without measuring DOAC plasma levels or reversal treatment. The unadjusted rate of sICH was 2.5% (95% CI, 1.6-3.8) in patients taking DOACs compared with 4.1% (95% CI, 3.9-4.4) in control patients using no anticoagulants. Recent DOAC ingestion was associated with lower odds of sICH after IVT compared with no anticoagulation (adjusted odds ratio, 0.57; 95% CI, 0.36-0.92). This finding was consistent among the different selection strategies and in sensitivity analyses of patients with detectable plasma levels or very recent ingestion.Conclusions and RelevanceIn this study, there was insufficient evidence of excess harm associated with off-label IVT in selected patients after ischemic stroke with recent DOAC ingestion.

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