Outcomes of early carotid stenting and angioplasty in large-vessel anterior circulation strokes treated with mechanical thrombectomy and intravenous thrombolytics

Introduction Proximal cervical internal carotid artery stenosis greater than 50% merits revascularization to mitigate the risk of stroke recurrence among large-vessel anterior circulation strokes undergoing mechanical thrombectomy. Carotid artery stenting necessitates the use of antiplatelets, and there is a theoretical increased risk of hemorrhagic transformation given that such patients may already have received intravenous thrombolytics and have a significant infarct burden. We investigate the outcomes of large-vessel anterior circulation stroke patients treated with intravenous thrombolytics receiving same-day carotid stenting or selective angioplasty compared to no carotid intervention. Materials and methods The study cohort was obtained from the National (Nationwide) Inpatient Sample database between 2006 and 2014, using International Statistical Classification of Diseases, ninth revision discharge diagnosis and procedure codes. A total of 11,825 patients with large-vessel anterior circulation stroke treated with intravenous thrombolytic and mechanical thrombectomy on the same day were identified. The study population was subdivided into three subgroups: no carotid intervention, same-day carotid angioplasty without carotid stenting, and same-day carotid stenting. Outcomes were assessed with respect to mortality, significant disability at discharge, hemorrhagic transformation, and requirement of percutaneous endoscopic gastronomy tube placement, prolonged mechanical ventilation, or craniotomy. Results This study found no statistically significant difference in patient outcomes in those treated with concurrent carotid stenting compared to no carotid intervention in terms of morbidity or mortality. Conclusions If indicated, it is reasonable to consider concurrent carotid stenting and/or angioplasty for large-vessel anterior circulation stroke patients treated with mechanical thrombectomy who also receive intravenous thrombolytics.

TC-PTP regulates the IL-7 transcriptional response during murine early T cell development

Cytokines play a critical role in directing the discrete and gradual transcriptional changes that define T cell development. The interleukin-7 receptor (IL-7R), via its activation of the JAK-STAT pathway, promotes gene programs that change dynamically as cells progress through T cell differentiation. The molecular mechanism(s) directing differential gene expression downstream of the IL-7R are not fully elucidated. Here, we have identified T cell protein tyrosine phosphatase (TC-PTP), also known as PTPN2, as a negative regulator of IL-7R-STAT signaling in T cell progenitors, contributing to both the quantitative and qualitative nature of STAT-gene targeting. Novel genetic strategies used to modulate TC-PTP expression demonstrate that depletion of TC-PTP expression heightens the phosphorylation of STAT family members, causing aberrant expression of an interferon-response gene profile. Such molecular re-programming results in deregulation of early development checkpoints culminating in inefficient differentiation of CD4⁺CD8⁺ double positive cells. TC-PTP is therefore shown to be required to safeguard the dynamic transcriptome necessary for efficient T cell differentiation.

Establishment of cell line with NK/NKT phenotype from myeloid NK cell acute leukemia

Acute Myeloid Leukemia (AML) is the most common malignancy in adults with a 5-year survival rate of 27% of the total affected population. For effective treatment and new drug discovery, cell lines are considered as a very important tool. Here we report an establishment of a continuous human cell line AML-004 with a hypo-diploid chromosome 44 and presence of both NK/NKT phenotypes. The cell line was isolated from the blood sample of myeloid NK cell acute leukemia patients and extensively characterized by flow cytometery, morphology, and cytogentic analysis. Cytotoxicity by standard chemotherapeutic drugs was also examined. As characterized by Giemsa staining, the predominant cell type in the culture had high nuclear/cytoplasmic ratio. Cytogenetic analysis revealed high chromosome instability and structural abnormalities confirming the source of cell line from a patient with AML. The karyotype of the isolated cells did not alter up to around 40 passages. These AML-004 cells lacked specific markers for B and T lymphoid cells, but expressed surface receptors for lymphoid/NK cells. Cells also lacked the presence of early progenitors. The proliferation of the isolated cells was inversely proportional to the IL-2 concentration confirming presence of NK phenotype. AML-004 was resistant against standard chemotherapeutic drugs excluding cisplatin. Thus, AML-004 cells provide a continuous source of human cells for designing novel therapies for patients with T-lymphoblastic leukemia/lymphoma.

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Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Interventions for hidradenitis suppurativa: a Cochrane systematic review incorporating GRADE assessment of evidence quality

More than 50 interventions have been used to treat hidradenitis suppurativa (HS), and so therapy decisions can be challenging. Our objective was to summarize and appraise randomized controlled trial (RCT) evidence for HS interventions in adults. Searches were conducted in Medline, Embase, CENTRAL, LILACS, five trials registers and abstracts from eight dermatology conferences until 13 August 2015. Two review authors independently assessed study eligibility, extracted data and assessed methodological quality. Primary outcomes were quality of life and adverse effects of the interventions. Twelve trials, from 1983 to 2015, investigating 15 different interventions met our inclusion criteria. The median trial duration was 16 weeks and the median number of participants was 27. Adalimumab 40 mg weekly improved the Dermatology Life Quality Index (DLQI) by 4·0 points, which equates to the minimal clinically important difference for the scale, compared with placebo (95% confidence interval -6·5 to -1·5 points). Evidence quality was reduced to 'moderate' because the results are based on only a single study. Adalimumab 40 mg every other week was ineffective in a meta-analysis of two studies comprising 124 participants. Infliximab 5 mg kg(-1) improved the DLQI score by 8·4 points after 8 weeks in a moderate-quality study completed by 33 of 38 participants. Etanercept 50 mg twice weekly was ineffective. Inclusion of a gentamicin sponge prior to primary closure did not improve outcomes. Other interventions, including topical and oral antibiotics, were investigated by relatively small studies, preventing treatment recommendations due to imprecision. More, larger RCTs are required to investigate most HS interventions, particularly oral treatments and surgical therapy. Moderate-quality evidence suggests that adalimumab given weekly and infliximab are effective, whereas adalimumab every other week is ineffective.

171 NORMAL VERSUS LOW ANTI-MULLERIAN HORMONE IN PATIENTS WITH ADVANCED MATERNAL AGE: IN VITRO FERTILIZATION OUTCOMES AND MORPHOKINETIC PARAMETERS

Anti-Mullerian hormone (AMH) levels are often used in an IVF population for assessment of ovarian reserve. However, it is not well understood whether AMH levels predict implantation and clinical pregnancy in older women undergoing IVF. In this study, we sought to compare IVF outcomes and morphokinetic parameters in patients 38 years and older with normal versus low AMH levels. Experimental design was a single-centre, retrospective cohort study. Time-lapse imaging data were evaluated for patients 38 years and older (n = 81). Patients were divided into those with AMH values less than 1.0 (n = 47) versus greater than or equal to 1.0 (n = 34). Morphokinetic data was then analysed from transferred blastocysts from these patients cultured in the Embryoscope until transfer (n = 100). The morphokinetic parameters examined were time to 2 cell (t2), 4 cell(t4), 5 cell (t5), time to synchronous divisions (s2, s3), duration of the second cell cycle (cc2), and third cell cycle (cc3). Implantation and clinical pregnancy were identified based upon the presence of a gestational sac. Fertilization, implantation, clinical pregnancy, and blastocyst formation rates were compared between normal and low AMH groups (Table 1). Mean morphokinetic parameters were compared between the 2 AMH groups using an unpaired t-test. Chi-squared tests were used for proportions. P < 0.05 was considered statistically significant. Results: Age of the patients ranged from 38–43, (41.3 ± 2.2 years). The results are summarised below. There were significant differences between implantation and clinical pregnancy rates for low and normal AMH levels. Morphokinetic parameters among the transferred embryos did not differ significantly between the 2 AMH groups (NS, data not shown). Conclusions: This initial data indicates that, in an IVF population 38 years and older, AMH levels greater than or equal to the cutoff of 1 ng mL–1 are associated not only with increased oocyte retrieval, but also with increased implantation rates and clinical pregnancy rates. These differences suggest that AMH may have a predictive role in determining the likelihood of clinical pregnancy in the 38 years and older patient population. Table 1.Oocyte harvest and IVF outcomes

Frailty and Health-Related Quality of Life in End Stage Renal Disease Patients of All Ages

BACKGROUND: Frailty is associated with worse health-related quality of life (HRQOL) in older adults and worse clinical outcomes in adults of all ages with end stage renal disease (ESRD). It is unclear whether frail adults of all ages with ESRD are more likely to experience worse HRQOL. OBJECTIVE: The goal of this study was to identify factors associated with worsening HRQOL in this population. DESIGN, SETTING AND MEASUREMENTS: We studied 233 adults of all ages with ESRD enrolled (11/2009-11/2013) in a longitudinal cohort study. Frailty status was measured at enrollment and HRQOL was reported (Excellent, Very Good, Good, Fair or Poor) at the initial assessment and follow-up (median follow-up 9.4 months). We studied factors associated with Fair/Poor HRQOL at follow-up using logistic regression and factors associated with HRQOL change using multinomial regression. All models were adjusted for age, sex, race, education, BMI, diabetes status, history of a previous transplant, type of dialysis and time between assessments. RESULTS: Fair/Poor HRQOL was reported by 28% at initial assessment and 33% at follow-up. 47.2% of participants had stable HRQOL, 22.8% better HRQOL, and 30.0% worse HRQOL at follow-up (P<0.001). In adjusted models, only frailty was associated with Fair/Poor HRQOL at follow-up (OR: 2.79, 95% CI: 1.32-5.90) and worsening HRQOL at follow-up (RR: 2.91, 95%CI: 1.08-7.80). CONCLUSIONS: Frail adults of all ages with ESRD are more likely to experience fair/poor HRQOL and worsening HRQOL over time. Frailty represents a state of decreased physiologic reserve that impacts not only clinical outcomes but also the patient-centered outcome of HRQOL.