1.External Validation of the ELAPSS Score for Prediction of Unruptured Intracranial Aneurysm Growth Risk
Mayte Sánchez VAN KAMMEN ; Jacoba P GREVING ; Satoshi KURODA ; Daina KASHIWAZAKI ; Akio MORITA ; Yoshiaki SHIOKAWA ; Toshikazu KIMURA ; Christophe COGNARD ; Anne C JANUEL ; Antti LINDGREN ; Timo KOIVISTO ; Juha E JÄÄSKELÄINEN ; Antti RONKAINEN ; Liisa PYYSALO ; Juha ÖHMAN ; Melissa RAHI ; Johanna KUHMONEN ; Jaakko RINNE ; Eva L LEEMANS ; Charles B MAJOIE ; W Peter VANDERTOP ; Dagmar VERBAAN ; Yvo B W E M ROOS ; René VAN DEN BERG ; Hieronymus D BOOGAARTS ; Walid MOUDROUS ; Ido R VAN DEN WIJNGAARD ; Laura ten HOVE ; Mario TEO ; Edward J ST GEORGE ; Katharina A M HACKENBERG ; Amr ABDULAZIM ; Nima ETMINAN ; Gabriël J E RINKEL ; Mervyn D I VERGOUWEN
Journal of Stroke 2019;21(3):340-346
BACKGROUND AND PURPOSE: Prediction of intracranial aneurysm growth risk can assist physicians in planning of follow-up imaging of conservatively managed unruptured intracranial aneurysms. We therefore aimed to externally validate the ELAPSS (Earlier subarachnoid hemorrhage, aneurysm Location, Age, Population, aneurysm Size and Shape) score for prediction of the risk of unruptured intracranial aneurysm growth. METHODS: From 11 international cohorts of patients ≥18 years with ≥1 unruptured intracranial aneurysm and ≥6 months of radiological follow-up, we collected data on the predictors of the ELAPSS score, and calculated 3- and 5-year absolute growth risks according to the score. Model performance was assessed in terms of calibration (predicted versus observed risk) and discrimination (c-statistic). RESULTS: We included 1,072 patients with a total of 1,452 aneurysms. During 4,268 aneurysm-years of follow-up, 199 (14%) aneurysms enlarged. Calibration was comparable to that of the development cohort with the overall observed risks within the range of the expected risks. The c-statistic was 0.69 (95% confidence interval [CI], 0.64 to 0.73) at 3 years, compared to 0.72 (95% CI, 0.68 to 0.76) in the development cohort. At 5 years, the c-statistic was 0.68 (95% CI, 0.64 to 0.72), compared to 0.72 (95% CI, 0.68 to 0.75) in the development cohort. CONCLUSIONS: The ELAPSS score showed accurate calibration for 3- and 5-year risks of aneurysm growth and modest discrimination in our external validation cohort. This indicates that the score is externally valid and could assist patients and physicians in predicting growth of unruptured intracranial aneurysms and plan follow-up imaging accordingly.
Aneurysm
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Calibration
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Cohort Studies
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Discrimination (Psychology)
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Follow-Up Studies
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Humans
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Intracranial Aneurysm
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Risk Factors
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Subarachnoid Hemorrhage
2.Etiology, 3-Month Functional Outcome and Recurrent Events in Non-Traumatic Intracerebral Hemorrhage
Martina B. GOELDLIN ; Achim MUELLER ; Bernhard M. SIEPEN ; Madlaine MUELLER ; Davide STRAMBO ; Patrik MICHEL ; Michael SCHAERER ; Carlo W. CEREDA ; Giovanni BIANCO ; Florian LINDHEIMER ; Christian BERGER ; Friedrich MEDLIN ; Roland BACKHAUS ; Nils PETERS ; Susanne RENAUD ; Loraine FISCH ; Julien NIEDERHAEUSER ; Emmanuel CARRERA ; Elisabeth DIRREN ; Christophe BONVIN ; Rolf STURZENEGGER ; Timo KAHLES ; Krassen NEDELTCHEV ; Georg KAEGI ; Jochen VEHOFF ; Biljana RODIC ; Manuel BOLOGNESE ; Ludwig SCHELOSKY ; Stephan SALMEN ; Marie-Luise MONO ; Alexandros A. POLYMERIS ; Stefan T. ENGELTER ; Philippe LYRER ; Susanne WEGENER ; Andreas R. LUFT ; Werner Z’GRAGGEN ; David BERVINI ; Bastian VOLBERS ; Tomas DOBROCKY ; Johannes KAESMACHER ; Pasquale MORDASINI ; Thomas R. MEINEL ; Marcel ARNOLD ; Javier FANDINO ; Leo H. BONATI ; Urs FISCHER ; David J. SEIFFGE ;
Journal of Stroke 2022;24(2):266-277
Background:
and Purpose Knowledge about different etiologies of non-traumatic intracerebral hemorrhage (ICH) and their outcomes is scarce.
Methods:
We assessed prevalence of pre-specified ICH etiologies and their association with outcomes in consecutive ICH patients enrolled in the prospective Swiss Stroke Registry (2014 to 2019). Results We included 2,650 patients (mean±standard deviation age 72±14 years, 46.5% female, median National Institutes of Health Stroke Scale 8 [interquartile range, 3 to 15]). Etiology was as follows: hypertension, 1,238 (46.7%); unknown, 566 (21.4%); antithrombotic therapy, 227 (8.6%); cerebral amyloid angiopathy (CAA), 217 (8.2%); macrovascular cause, 128 (4.8%); other determined etiology, 274 patients (10.3%). At 3 months, 880 patients (33.2%) were functionally independent and 664 had died (25.1%). ICH due to hypertension had a higher odds of functional independence (adjusted odds ratio [aOR], 1.33; 95% confidence interval [CI], 1.00 to 1.77; P=0.05) and lower mortality (aOR, 0.64; 95% CI, 0.47 to 0.86; P=0.003). ICH due to antithrombotic therapy had higher mortality (aOR, 1.62; 95% CI, 1.01 to 2.61; P=0.045). Within 3 months, 4.2% of patients had cerebrovascular events. The rate of ischemic stroke was higher than that of recurrent ICH in all etiologies but CAA and unknown etiology. CAA had high odds of recurrent ICH (aOR, 3.38; 95% CI, 1.48 to 7.69; P=0.004) while the odds was lower in ICH due to hypertension (aOR, 0.42; 95% CI, 0.19 to 0.93; P=0.031).
Conclusions
Although hypertension is the leading etiology of ICH, other etiologies are frequent. One-third of ICH patients are functionally independent at 3 months. Except for patients with presumed CAA, the risk of ischemic stroke within 3 months of ICH was higher than the risk of recurrent hemorrhage.
3.Antibacterial and antibiotic potentiating capabilities of extracts isolated from Burkillanthus malaccensis, Diospyros hasseltii and Cleisthanthus bracteosus against human pathogenic bacteria
Kathirvalu, G. ; Chandramathi, S. ; Azahar, S.A. ; Atiya, N. ; Begum, S. ; Christophe, W. ; Sulaiman, M. ; Abdullah, N. ; Mani, R.R. ; Jindal, H.M. ; Zulkipli, M.
Tropical Biomedicine 2023;40(No.2):152-159
Antibiotics which once a boon in medicine and saved millions of lives are now facing an ever-growing
menace of antibacterial resistance, which desperately needs new antibacterial drugs which are innovative
in chemistry and mode of action. For many years, the world has turned to natural plants with antibacterial
properties to combat antibiotic resistance. On that basis, we aimed to identify plants with antibacterial
and antibiotic potentiating properties. Seventeen different extracts of 3 plants namely Burkillanthus
malaccensis, Diospyros hasseltii and Cleisthanthus bracteosus were tested against multi-drug resistant
Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Methicillinresistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA).
Antibacterial activity of hexane, methanol and chloroform extracts of bark, seed, fruit, flesh and leaves
from these plants were tested using, disk diffusion assay, minimum inhibitory concentration (MIC) and
minimum bactericidal concentration (MBC) assays. Antibiotic potentiating capabilities were tested using
time-kill assay. B. malaccensis fruit chloroform extract showed the biggest zone of inhibition against MRSA
(13.00±0.0 mm) but C. bracteosus bark methanol extract showed the biggest inhibition zone against
MSSA (15.33±0.6 mm). Interestingly, bark methanol extract of C. bracteosus was active against MRSA
(8.7±0.6 mm), MSSA (7.7±0.6 mm) (Gram-positive) and A. baumannii (7.7±0.6 mm) (Gram-negative).
Overall, the leaf methanol and bark methanol extract of C. bracteosus warrants further investigation
such as compound isolation and mechanism of action for validating its therapeutic use as antibiotic
potentiator importantly against MRSA and A. baumannii.
4.Male Oxidative Stress Infertility (MOSI): Proposed Terminology and Clinical Practice Guidelines for Management of Idiopathic Male Infertility
Ashok AGARWAL ; Neel PAREKH ; Manesh Kumar PANNER SELVAM ; Ralf HENKEL ; Rupin SHAH ; Sheryl T HOMA ; Ranjith RAMASAMY ; Edmund KO ; Kelton TREMELLEN ; Sandro ESTEVES ; Ahmad MAJZOUB ; Juan G ALVAREZ ; David K GARDNER ; Channa N JAYASENA ; Jonathan W RAMSAY ; Chak Lam CHO ; Ramadan SALEH ; Denny SAKKAS ; James M HOTALING ; Scott D LUNDY ; Sarah VIJ ; Joel MARMAR ; Jaime GOSALVEZ ; Edmund SABANEGH ; Hyun Jun PARK ; Armand ZINI ; Parviz KAVOUSSI ; Sava MICIC ; Ryan SMITH ; Gian Maria BUSETTO ; Mustafa Emre BAKIRCIOĞLU ; Gerhard HAIDL ; Giancarlo BALERCIA ; Nicolás Garrido PUCHALT ; Moncef BEN-KHALIFA ; Nicholas TADROS ; Jackson KIRKMAN-BROWNE ; Sergey MOSKOVTSEV ; Xuefeng HUANG ; Edson BORGES ; Daniel FRANKEN ; Natan BAR-CHAMA ; Yoshiharu MORIMOTO ; Kazuhisa TOMITA ; Vasan Satya SRINI ; Willem OMBELET ; Elisabetta BALDI ; Monica MURATORI ; Yasushi YUMURA ; Sandro LA VIGNERA ; Raghavender KOSGI ; Marlon P MARTINEZ ; Donald P EVENSON ; Daniel Suslik ZYLBERSZTEJN ; Matheus ROQUE ; Marcello COCUZZA ; Marcelo VIEIRA ; Assaf BEN-MEIR ; Raoul ORVIETO ; Eliahu LEVITAS ; Amir WISER ; Mohamed ARAFA ; Vineet MALHOTRA ; Sijo Joseph PAREKATTIL ; Haitham ELBARDISI ; Luiz CARVALHO ; Rima DADA ; Christophe SIFER ; Pankaj TALWAR ; Ahmet GUDELOGLU ; Ahmed M A MAHMOUD ; Khaled TERRAS ; Chadi YAZBECK ; Bojanic NEBOJSA ; Damayanthi DURAIRAJANAYAGAM ; Ajina MOUNIR ; Linda G KAHN ; Saradha BASKARAN ; Rishma Dhillon PAI ; Donatella PAOLI ; Kristian LEISEGANG ; Mohamed Reza MOEIN ; Sonia MALIK ; Onder YAMAN ; Luna SAMANTA ; Fouad BAYANE ; Sunil K JINDAL ; Muammer KENDIRCI ; Baris ALTAY ; Dragoljub PEROVIC ; Avi HARLEV
The World Journal of Men's Health 2019;37(3):296-312
Despite advances in the field of male reproductive health, idiopathic male infertility, in which a man has altered semen characteristics without an identifiable cause and there is no female factor infertility, remains a challenging condition to diagnose and manage. Increasing evidence suggests that oxidative stress (OS) plays an independent role in the etiology of male infertility, with 30% to 80% of infertile men having elevated seminal reactive oxygen species levels. OS can negatively affect fertility via a number of pathways, including interference with capacitation and possible damage to sperm membrane and DNA, which may impair the sperm's potential to fertilize an egg and develop into a healthy embryo. Adequate evaluation of male reproductive potential should therefore include an assessment of sperm OS. We propose the term Male Oxidative Stress Infertility, or MOSI, as a novel descriptor for infertile men with abnormal semen characteristics and OS, including many patients who were previously classified as having idiopathic male infertility. Oxidation-reduction potential (ORP) can be a useful clinical biomarker for the classification of MOSI, as it takes into account the levels of both oxidants and reductants (antioxidants). Current treatment protocols for OS, including the use of antioxidants, are not evidence-based and have the potential for complications and increased healthcare-related expenditures. Utilizing an easy, reproducible, and cost-effective test to measure ORP may provide a more targeted, reliable approach for administering antioxidant therapy while minimizing the risk of antioxidant overdose. With the increasing awareness and understanding of MOSI as a distinct male infertility diagnosis, future research endeavors can facilitate the development of evidence-based treatments that target its underlying cause.
Antioxidants
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Classification
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Clinical Protocols
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Diagnosis
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DNA
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Embryonic Structures
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Female
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Fertility
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Health Expenditures
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Humans
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Infertility
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Infertility, Male
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Male
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Membranes
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Ovum
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Oxidants
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Oxidation-Reduction
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Oxidative Stress
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Reactive Oxygen Species
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Reducing Agents
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Reproductive Health
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Semen
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Spermatozoa
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Subject Headings