Background: and Purpose The accurate prediction of functional outcomes in patients with acute ischemic stroke (AIS) is crucial for informed clinical decision-making and optimal resource utilization. As such, this study aimed to construct an ensemble deep learning model that integrates multimodal imaging and clinical data to predict the 90-day functional outcomes after AIS. Methods: We used data from the Korean Stroke Neuroimaging Initiative database, a prospective multicenter stroke registry to construct an ensemble model integrated individual 3D convolutional neural networks for diffusion-weighted imaging and fluid-attenuated inversion recovery (FLAIR), along with a deep neural network for clinical data, to predict 90-day functional independence after AIS using a modified Rankin Scale (mRS) of 3–6. To evaluate the performance of the ensemble model, we compared the area under the curve (AUC) of the proposed method with that of individual models trained on each modality to identify patients with AIS with an mRS score of 3–6. Results: Of the 2,606 patients with AIS, 993 (38.1%) achieved an mRS score of 3–6 at 90 days post-stroke. Our model achieved AUC values of 0.830 (standard cross-validation [CV]) and 0.779 (time-based CV), which significantly outperformed the other models relying on single modalities: b-value of 1,000 s/mm2 (P<0.001), apparent diffusion coefficient map (P<0.001), FLAIR (P<0.001), and clinical data (P=0.004). Conclusion The integration of multimodal imaging and clinical data resulted in superior prediction of the 90-day functional outcomes in AIS patients compared to the use of a single data modality.

Background: and Purpose We investigated the impact of comorbidity burden on troponin elevation, with separate consideration of neurological conditions, in patients with acute ischemic stroke (AIS). Methods: This prospective, observational cohort study consecutively enrolled patients with AIS for 2 years. Serum cardiac troponin I was repeatedly measured, and disease-related biomarkers were collected for diagnosis of preassigned comorbidities, including atrial fibrillation (AF), ischemic heart disease (IHD), myocardial hypertrophy (MH), heart failure (HF), renal insufficiency (RI), and active cancer. The severity of neurological deficits and insular cortical ischemic lesions were assessed as neurological conditions. Adjusted associations between these factors and troponin elevation were determined using a multivariate ordinal logistic regression model and area under the receiver operating characteristic curve (AUC). Cox proportional hazards model was used to determine the prognostic significance of comorbidity beyond neurological conditions. Results: Among 1,092 patients (66.5±12.4 years, 63.3% male), 145 (13.3%) and 335 (30.7%) had elevated (≥0.040 ng/mL) and minimally-elevated (0.040–0.010 ng/mL) troponin, respectively. In the adjusted analysis, AF, MH, HF, RI, active cancer, and neurological deficits were associated with troponin elevation. The multivariate model with six comorbidities and two neurological conditions exhibited an AUC of 0.729 (95% confidence interval [CI], 0.698–0.759). In Cox regression, AF, IHD, and HF were associated with adverse cardio-cerebrovascular events, whereas HF and active cancer were associated with mortality. Conclusion Troponin elevation in patients with AIS can be explained by the burden of comorbidities in combination with neurological status, which explains the prognostic significance of troponin assay.

OBJECTIVE: Syncope is mostly benign, but it can also be caused by a life-threatening situation. In Korea, no studies have investigated application of the Canadian Syncope Risk Score (CSRS) to patients with syncope; therefore, this study was started to evaluate the usefulness of CSRS. METHODS: A total of 222 patients who visited the emergency room with syncope for one year from January 2016 to December 2016 were enrolled in this study. Patients were divided into two groups, a serious adverse events (SAE) group and a non-serious adverse events group. The scores of the nine CSRS variables were added and the CSRS was then calculated after the addition. RESULTS: The CSRS score for patients with SAE ranged from 0 to 8. The CSRS score was 18.6%, 31.7%, 55.6%, and 58.8% for 0, 1, 2, and 3, respectively. In the case of CSRS 0 and 1, 17 patients (81.0%) and 11 patients (84.6%) were non-cardiac. In the case of CSRS 2, 7 were non-cardiac (70.0%). In the case of CSRS 3, 6 cases (60.0%) were cardiogenic and 4 cases (40.0%) were non-cardiogenic. The area under the receiver operating characteristic curve of CSRS to predict SAE was 0.71. Setting the CSRS cutoff value to 0, we found that sensitivity and specificity of predicting SAE was 67.19% and 67.09%, respectively. CONCLUSION: CSRS may be difficult to predict for acute intracranial disease or acute hemorrhagic disease requiring transfusion; therefore, it is necessary to supplement it further.
Emergencies* ; Emergency Service, Hospital ; Humans ; Korea* ; Risk Factors ; ROC Curve ; Sensitivity and Specificity ; Syncope*

PURPOSE: The purpose of this study was to evaluate the efficacy and safety of closely sequential carotid endarterectomies (CEAs) for bilateral internal carotid artery stenosis. METHODS: From September 1995 to December 2011, 953 CEAs were performed for internal carotid artery occlusive disease in Asan Medical Center. Seven hundreds eighty-five patients received unilateral CEA, and 84 patients received bilateral CEAs. Of the 84 patients with bilateral CEAs, 15 who underwent closely sequential CEAs with an intersurgical period of 7 days were included in this study. Retrospectively, surgical outcomes were evaluated and compared, regarding CEA-related parameters, and early and late mortality and morbidity rates between patients with closely sequential bilateral CEAs and unilateral CEA. RESULTS: With this strategy, initial CEA was performed for the symptomatic side in symptomatic patients, or for the higher-grade carotid stenosis in asymptomatic patients. All 15 patients received contralateral CEA 7 days after initial CEA, and sufficient revascularization was obtained in all procedures. With a mean follow-up of 11.7 months, there were no perioperative neurological complications or strokes. During the follow-up period, early and late complications, except for transient cranial nerve injury, occurred without statistically significant difference between unilateral CEA and closely sequential bilateral CEAs. CONCLUSION: Closely sequential bilateral CEAs showed excellent early and late clinical outcomes. Although the number of patients included in the study was few, our results demonstrated that closely sequential bilateral CEAs were safe and effective strategies for bilateral internal carotid artery stenosis. In addition, future clinical studies will be needed, with a greater number of patients.
Carotid Artery, Internal ; Carotid Stenosis ; Cranial Nerve Injuries ; Endarterectomy ; Endarterectomy, Carotid ; Follow-Up Studies ; Humans ; Retrospective Studies ; Stroke

No abstract available.
Colorectal Neoplasms ; Diabetes Mellitus, Type 2

BACKGROUND: There is a close connection between type 2 diabetes mellitus and the risk of cancers and related mortality. The principal objective of the present study was to explore the association between type 2 diabetes and colorectal cancer. METHODS: We retrospectively compared 1111 subjects (age > or = 30 years) who were subjected to colonoscopies between June 2006 and June 2009. We evaluated the anthropometric data, presenting symptoms and signs, history of diabetes, laboratory data, colonoscopy findings and biopsy results. We analyzed the correlation between colorectal cancer and influencing factors, and compared the incidence rates of colorectal cancer in the type 2 diabetes and control groups. RESULTS: Four hundreds and seven of the subjects had diabetes mellitus. The incidence of colorectal cancer was increased significantly in type 2 diabetes relative to the control group (7.4% vs. 3.4%, P < 0.05). Colorectal cancer was correlated significantly with age, type 2 diabetes, constipation, anemia, and gastrointestinal symptoms. Following logistic regression analysis, age and constipation were associated significantly with colorectal cancer. In the age below 65 years subgroup, the incidence of colorectal cancer was increased significantly in the type 2 diabetes group relative to the control group. CONCLUSION: Type 2 diabetes was associated with increased colorectal cancer risk. This association was more definite in the subjects younger than 65 years.
Anemia ; Biopsy ; Colonoscopy ; Colorectal Neoplasms ; Constipation ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Incidence ; Logistic Models ; Retrospective Studies

We report herein a case of subclavian steal syndrome due to occlusive disease in multiple branches of the aortic arch, which was successfully treated by axilloaxillary bypass and subclavian stent insertion. The hemodynamic changes were evaluated using duplex sonography and transcranial Doppler before and after each procedure. The waveform and parameters of blood flow revealed an objective improvement in cerebral perfusion. These findings correlated well with clinical outcome. Neurosonologic evaluation can provide objective evidence for improved hemodynamic status after treatment.
Aorta, Thoracic ; Hemodynamics ; Perfusion ; Stents ; Subclavian Steal Syndrome