A cortically-weighted versus total Alberta Stroke Program Early Computed Tomography Score in thrombectomy outcome models

OBJECTIVES

Individual subcortical infarct scoring for the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) can be difficult and is subjected to higher inter-reader variability. This study compares performance of the 10-point ASPECTS with a new 7-point cortically-weighted score in predicting post-thrombectomy functional outcomes.

MATERIALS AND METHODS

Prospective registry data from two comprehensive stroke centers (Site 1 2016-2021; Site 2: 2019-2021) included patients with either M1 segment of middle cerebral artery or internal carotid artery occlusions who underwent thrombectomy. Two multivariate proportional odds training models utilizing either 10-point or 7-point ASPECTS predicting 90-day shift in modified Rankin score were generated using Site 1 data and validated with Site 2 data. Models were compared using multiclass receiver operator characteristics, corrected Akaike's Information Criterion, and likelihood ratio test.

RESULTS

Of 328 patients (Site 1 = 181, Site 2 = 147), median age was 71y (IQR 61-82), 119 (36%) had internal carotid artery occlusions, and median 10-point ASPECTS was 9 (IQR 8-10). There was no difference in performance between models using either total or cortically-weighted ASPECTS (p=0.14). Validation cohort data were correctly (i.e., predicting modified Rankin score within one point) classified 50% (cortically-weighted score model) and 56% (total score model) of the time.

CONCLUSIONS

The 7-point cortically-weighted ASPECTS was similarly predictive of post-thrombectomy functional outcome as 10-point ASPECTS. Given noninferior performance, the cortically-weighted score is a potentially reliable, but simplified, alternative to the traditional scoring paradigm, with potential implications in automated image analysis tool development.

Correlating Age and Hematoma Volume with Extent of Midline Shift in Acute Subdural Hematoma Patients: Validation of an Artificial Intelligence Tool for Volumetric Analysis

OBJECTIVE

Decision for intervention in acute subdural hematoma patients is based on a combination of clinical and radiographic factors. Age has been suggested as a factor to be strongly considered when interpreting midline shift (MLS) and hematoma volume data for assessing critical clinical severity during operative intervention decisions for acute subdural hematoma patients. The objective of this study was to demonstrate the use of an automated volumetric analysis tool to measure hematoma volume and MLS and quantify their relationship with age.

METHODS

A total of 1789 acute subdural hematoma patients were analyzed using qER-Quant software (Qure.ai, Mumbai, India) for MLS and hematoma volume measurements. Univariable and multivariable regressions analyzed association between MLS, hematoma volume, age, and MLS:hematoma volume ratio.

RESULTS

In comparison to young patients (≤ 70 years), old patients (>70 years) had significantly higher average hematoma volume (old: 62.2 mL vs. young 46.8 mL, P < 0.0001), lower average MLS (old: 6.6 mm vs. young: 7.4 mm, P = 0.025), and lower average MLS:hematoma volume ratio (old: 0.11 mm/mL vs. young 0.15 mm/mL, P < 0.0001). Young patients had an average of 1.5 mm greater MLS for a given hematoma volume in comparison to old patients. With increasing age, the ratio between MLS and hematoma volume significantly decreases (P = 0.0002).

CONCLUSIONS

Commercially available, automated, artificial intelligence (AI)-based tools may be used for obtaining quantitative radiographic measurement data in patients with acute subdural hematoma. Our quantitative results are consistent with the qualitative relationship previously established between age, hematoma volume, and MLS, which supports the validity of using AI-based tools for acute subdural hematoma volume estimation.

The effect of patient age on the degree of midline shift caused by chronic subdural hematomas: a volumetric analysis

OBJECTIVE

Chronic subdural hematomas (CSDHs) are the among the most common conditions treated by neurosurgeons. Midline shift (MLS) is used as a radiological marker of CSDH severity and the potential need for urgent surgical evacuation. However, a patient's age may affect the degree of MLS for a given hematoma volume. This study aimed to investigate the correlation between the patient's age and the MLS caused by CSDH.

METHODS

The database of patients treated for CSDH was reviewed in a single institution. Patients with unilateral CSDH were included. To measure CSDH volume, the preprocedural head CT scans underwent 3D volumetric reconstruction using the TeraRecon software. The effect of age on MLS after adjusting for CSDH volume was investigated using linear regression analysis.

RESULTS

Sixty-nine hematomas in 69 patients were included. The age of patients ranged from 25 to 94 years (mean 71.6 years). Hematoma volume and MLS ranged from 27.8 to 215 mL (mean 99.3 mL) and 0-17 mm (mean 6.5 mm), respectively. On multivariate regression analysis, MLS showed a significant independent negative correlation with age after adjusting for CSDH volume (OR -0.11, 95% CI -0.16 to -0.06; p < 0.001), meaning that for a fixed CSDH volume, with each 10-year increase in age the MLS will reduce by 1.1 mm. Moreover, MLS-to-volume ratio showed a significant negative linear correlation with age (r2 = 0.32; p < 0.001). Ten-milliliter increments in CSDH volume resulted in a 1.09-mm increase in MLS in patients younger than 60 years, which is 2.4-fold higher compared to the 0.46-mm increase in those older than 75 years (p < 0.001).

CONCLUSIONS

For a fixed CSDH volume, older age correlates with significantly lower MLS. This could be explained by higher parenchymal compliance in older individuals due to increased brain atrophy, and a larger subdural space. Clinical use of MLS to estimate severity of CSDH and gauge treatment decisions should take the patient's age into account.

U.S. public perceptions of the sensitivity of brain data

As we approach an era of potentially widespread consumer neurotechnology, scholars and organizations worldwide have started to raise concerns about the data privacy issues these devices will present. Notably absent in these discussions is empirical evidence about how the public perceives that same information. This article presents the results of a nationwide survey on public perceptions of brain data, to inform discussions of law and policy regarding brain data governance. The survey reveals that the public may perceive certain brain data as less sensitive than other 'private' information, like social security numbers, but more sensitive than some 'public' information, like media preferences. The findings also reveal that not all inferences about mental experiences may be perceived as equally sensitive, and perhaps not all data should be treated alike in ethical and policy discussions. An enhanced understanding of public perceptions of brain data could advance the development of ethical and legal norms concerning consumer neurotechnology.

Abstract P567: Cardiovascular Health Awareness and Risk Assessment in Schoolteachers in Calcutta, India

Background: Cardiovascular disease (CVD) is the leading cause of death in India, surpassing all infectious causes. Early awareness of CVD and its risk factors and adoption of heart healthy lifestyle practices are crucial to reducing the impact of CVD in the community.

Objective: To assess schoolteachers’ awareness of CVD and to compare the calculated ten-year risk of heart attack, stroke, and death by the Atherosclerotic Cardiovascular Disease (ASCVD) model to the observed event rates.

Methods: We surveyed 4,150 schoolteachers out of 5,321 (78% response rate) from 400 schools in Calcutta during 2019 using a questionnaire assessing their awareness of CVD in five domains: prevalence, spectrum of CVD, its nature, risk factors, and benefits of a heart healthy lifestyle. The study population was stratified by risk tertile of their 10-year calculated ASCVD score.

Results: Awareness about cardiovascular health among schoolteachers (male 41%, mean age 44 years) was low: 33 (mean score out of maximum 100), varying in different domains as shown below.

Although most (86%) were at mild risk for CVD with ASCVD scores below five, nine percent had moderate risk, and five percent had high risk of CVD. There was no significant association between their risk score and their awareness of CVD health (correlation coefficient r = - 0.022, 95% confidence interval - 0.052, 0.009).

Conclusions: Cardiovascular health awareness among schoolteachers in Calcutta is suboptimal, many of whom are at risk for CVD. Awareness of the disease, detection of risk factors at an early stage, and adoption of a healthy lifestyle may help reduce CVD in this community.

Properties of attractors of canalyzing random Boolean networks

We study critical random Boolean networks with two inputs per node that contain only canalyzing functions. We present a phenomenological theory that explains how a frozen core of nodes that are frozen on all attractors arises. This theory leads to an intuitive understanding of the system's dynamics as it demonstrates the analogy between standard random Boolean networks and networks with canalyzing functions only. It reproduces correctly the scaling of the number of nonfrozen nodes with system size. We then investigate numerically attractor lengths and numbers, and explain the findings in terms of the properties of relevant components. In particular we show that canalyzing networks can contain very long attractors, albeit they occur less often than in standard networks.

Selected cephalometric norms in south Kanara children

Cephalometric Norms from forty South Kanara children were selected and it was found that these children have a tendency towards class II skeletal relation. Females showed a protrusive Maxillary and Mandibular base. Certain new landmarks were also introduced, the value of which gives the molar relationship. Length of Maxillary and Mandibular bases were also standardised for class I cases.

[CHARTWEL-Bronchus (ARO 97-1): a randomized multicenter trial to compare conventional fractionated radiotherapy with CHARTWEL radiotherapy in inoperable non-small-call bronchial carcinoma]

BACKGROUND

The CHART-bronchus trial sponsored by the Medical Research Council showed an improvement in survival of 10% compared to conventional fractionation to 60 Gy when patients with inoperable non-small-cell lung cancer (NSCLC) were treated with CHART to 54 Gy. At present it is not known whether this survival advantage holds when the dose of conventional treatment is increased and whether CHART can be replaced by the more practicable CHARTWEEL (CHART-weekend less).

PROTOCOL OF THE TRIAL

A randomized multicenter trial of definite radiotherapy in locally advanced inoperable NSCLC was designed (ARO 97-1, Arbeitsgemeinschaft Radioonkologie der Deutschen Krebsgesellschaft). Conventional fractionation to 66 Gy (5 weekly fractions of 2 Gy) is compared with CHARTWEEL to 60 Gy (15 weekly fractions of 1.5 Gy, Monday to Friday, interval between fractions > or = 6 hours, overall treatment time 2.5 weeks). The main endpoint of the trial is overall survival. It was calculated that an entry of 665 patients is needed to detect an improvement in 2-year survival of 10%, the actual time is estimated to be 5 years or less. The trial was activated on 1.9.1997.