A2DS2 Score Combined With Clinical and Neuroimaging Factors Better Predicts Stroke-Associated Pneumonia in Hyperacute Cerebral Infarction.

OBJECTIVE: To investigate the predictors of stroke-associated pneumonia (SAP) and poor functional outcome in patients with hyperacute cerebral infarction (HCI) by combining clinical factors, laboratory tests and neuroimaging features. METHODS: We included 205 patients with HCI from November 2018 to December 2019. The diagnostic criterion for SAP was occurrence within 7 days of the onset of stroke. Poor outcome was defined as a functional outcome based on a 3-months MRS score >3. The relationship of demographic, laboratory and neuroimaging variables with SAP and poor outcome was investigated using univariate and multivariate analyses. RESULTS: Fifty seven (27.8%) patients were diagnosed with SAP and 40 (19.5%) developed poor outcomes. A2DS2 score (OR = 1.284; 95% CI: 1.048-1.574; P = 0.016), previous stroke (OR = 2.630; 95% CI: 1.122-6.163; P = 0.026), consciousness (OR = 2.945; 95% CI: 1.514-5.729; P < 0.001), brain atrophy (OR = 1.427; 95% CI: 1.040-1.959; P = 0.028), and core infarct volume (OR = 1.715; 95% CI: 1.163-2.528; P = 0.006) were independently associated with the occurrence of SAP. Therefore, we combined these variables into a new SAP prediction model with the C-statistic of 0.84 (95% CI: 0.78-0.90). Fasting plasma glucose (OR = 1.404; 95% CI: 1.202-1.640; P < 0.001), NIHSS score (OR = 1.088; 95% CI: 1.010-1.172; P = 0.026), previous stroke (OR = 4.333; 95% CI: 1.645-11.418; P = 0.003), SAP (OR = 3.420; 95% CI: 1.332-8.787; P = 0.011), basal ganglia-dilated perivascular spaces (BG-dPVS) (OR = 2.124; 95% CI: 1.313-3.436; P = 0.002), and core infarct volume (OR = 1.680; 95% CI: 1.166-2.420; P = 0.005) were independently associated with poor outcome. The C-statistic of the outcome model was 0.87 (95% CI: 0.81-0.94). Furthermore, the SAP model significantly improved discrimination and net benefit more than the A2DS2 scale, with a C-statistic of 0.76 (95% CI: 0.69-0.83). CONCLUSIONS: After the addition of neuroimaging features, the models exhibit good differentiation and calibration for the prediction of the occurrence of SAP and the development of poor outcomes in HCI patients. The SAP model could better predict the SAP, representing a helpful and valid tool to obtain a net benefit compared with the A2DS2 scale.

Quantitative Ischemic Characteristics and Prognostic Analysis of Crossed Cerebellar Diaschisis in Hyperacute Ischemic Stroke.

OBJECTIVES: Crossed cerebellar diaschisis (CCD) is a secondary phenomenon caused by supratentorial brain injury, characterized by hypoperfusion and hypometabolism of the contralateral cerebellum. This study aimed to investigate the correlation between the quantitative data of initial supratentorial ischemia and CCD, and to further explore the prognosis value of CCD in the hyperacute phase. MATERIALS AND METHODS: The imaging and clinical data of 109 patients with hyperacute ischemic stroke were analyzed retrospectively, univariate analysis and multivariate logistic regression were used to observe the relationship between the volume and degree of initial supratentorial ischemia and CCD, respectively, and to further analyze the effects of CCD in the hyperacute phase on neurological function and clinical prognosis. RESULTS: The degree and volume of initial supratentorial ischemia was significantly correlated with hyperacute CCD. The volume of ischemic penumbra (OR=1.021 [95% CI: 1.009-1.033], P<0.001) and the reduction rate of cerebral blood volume (CBV) (OR=1.338 [95% CI: 1.073-1.668], P=0.01) were the main influencing factors of CCD; patients with hyperacute CCD had higher admission and discharge National Institutes of Health Stroke Scale (NIHSS) (P=0.046 and P=0.01), and more hemorrhagic transformation (P=0.021), but there was no significant difference in the final infarction volume (P=0.347) and the 90-day modified Rankin Scale (mRS) (P=0.757). CONCLUSION: Patients with CCD had larger initial supratentorial ischemic volume and more severe ischemic degree in the hyperacute ischemic stroke, more short-term neurological impairment, and worse short-term treatment effect, however, but the long-term functional prognosis was not be affected.

[Clinical Outcomes of the Scleral Fixation of Posterior Chamber Intraocular Lens using the Modified Yamane's Technique: a Swept-source Optical Coherence Tomography Study].

OBJECTIVE: To observe the postoperative outcomes of the scleral fixation of posterior chamber intraocular lens (SF-PCIOL) using the modified Yamane's technique with the aid of swept-source optical coherence tomography (SS-OCT). METHODS: Prospective observational case series. This study involved 20 patients who underwent SF-PCIOL with the modified Yamane's technique, from December 2017 to November 2019. All patients had routine preoperative examinations, including biometric measurement by IOL master, measurements of uncorrected distance visual acuity (UDVA) and best corrected distance visual acuity (BCDVA). The SRK/T formula was used to calculate the power of intraocular lens (IOL). After the surgery, UDVA and intraocular pressure were evaluated for 1 d, UDVA, BCDVA, spherical equivalent (SE) and corneal endothelial cell density were measured for 1 week, 1 month, 3 and 6 months, respectively. The IOL tilt and the symmetry of hepatitis in the scleral tunnel were measured by SS-OCT. RESULTS: The mean follow-up duration was (7.20±6.56) months (range, 3-26 months). The mean preoperative UDVA was (1.70±0.38) LogMAR, and it improved to (0.48±0.50) LogMAR ( P=0.001). There was no statistically significant difference between the pre- and post-operative BCDVA, i.e. (0.44±0.50) LogMAR and (0.32±0.48) LogMAR, respectively ( P=0.08). The mean spherical equivalent was (-0.53±0.86) diopter (D) and the postoperative refractive error was (0.27±0.82) D. Seventeen patients underwent SS-OCT examinations. The mean IOL tilt was (3.28±3.00)°. There was no significant difference between the horizontal and vertical tilt ( P=0.326). The IOL tilt did not show a significant correlation with spherical and cylindrical refractive error ( P=0.532, P=0.241). There was no statistically significant difference in the HL (the length of haptics fixed in the scleral tunnel) of nasal and temporal haptic, which were (2.24±0.20) mm and (2.17±0.23) mm, respectively ( P=0.193). And there were no statistically significant differences between the HD (the distance between the center of haptic flange and scleral spur) of nasal and temporal haptic, (1.58±0.07) mm and (1.66±0.08) mm, respectively ( P=0.338). The changes of IOL haptics in the scleral tunnel were tracked by 10 patients. The HL (nasal: HL-N; temporal: HL-T) and the HD (nasal: HD-N; temporal: HD-T) of haptics in the tunnel were measured and recorded at three time points, including 1 week, 1 and 3 months after surgery. There was no significant difference in HL-N, HL-T, HD-N and HD-T at the three time points ( P=0.931, P=0.091, P=0.175, and P=0.505, respectively). All patients underwent uneventful surgery. The postoperative complications included transient corneal edema in 6 eyes, transient IOP elevation in 3 eyes, vitreous hemorrhage in 1 eye, cystoid macular edema in 2 eyes, and macular hole in 1 eye. CONCLUSION: The SF-PCIOL using modified Yamane's technique, is capable of producing satisfactory and consistent postoperative outcomes for patients with few postoperative complications. SS-OCT is a powerful tool for measuring optic tilt and the IOL hepatic symmetry in scleral tunnel.