Melanie Hicks, J. Bishop, Brenton T. Bicknell, J. Grayson, B. Woodworth, D. Cho
Acute invasive fungal sinusitis (AIFS) is a rapidly progressing, life-threatening infection. The advent of immunomodulatory therapies has expanded the population susceptible to AIFS. In this case report, we describe a patient who defies the conventional profile of AIFS. This 70-year-old woman is immunocompetent and non-diabetic, with a history of multiple sclerosis (MS) and ongoing treatment with glatiramer acetate (GA), immunomodulator. She came to the emergency room due to acute vision changes, and images revealed an enhancing mass in the left pterygopalatine fossa. The diagnosis of AIFS was confirmed by biopsy in the operating room. Subsequently, anti-fungal therapies were initiated with a follow-up operative debridement. Follow-up magnetic resonance imaging (10 months since treatment) showed no progression of AIFS. GA was discontinued since the diagnosis, and MS has remained stable. Recognizing this unique group of atrisk patients is crucial, as early detection and treatment play a pivotal role in preventing significant morbidity and mortality.
{"title":"A case of acute invasive fungal sinusitis in an immunocompetent patient on glatiramer acetate therapy","authors":"Melanie Hicks, J. Bishop, Brenton T. Bicknell, J. Grayson, B. Woodworth, D. Cho","doi":"10.23838/pfm.2023.00114","DOIUrl":"https://doi.org/10.23838/pfm.2023.00114","url":null,"abstract":"Acute invasive fungal sinusitis (AIFS) is a rapidly progressing, life-threatening infection. The advent of immunomodulatory therapies has expanded the population susceptible to AIFS. In this case report, we describe a patient who defies the conventional profile of AIFS. This 70-year-old woman is immunocompetent and non-diabetic, with a history of multiple sclerosis (MS) and ongoing treatment with glatiramer acetate (GA), immunomodulator. She came to the emergency room due to acute vision changes, and images revealed an enhancing mass in the left pterygopalatine fossa. The diagnosis of AIFS was confirmed by biopsy in the operating room. Subsequently, anti-fungal therapies were initiated with a follow-up operative debridement. Follow-up magnetic resonance imaging (10 months since treatment) showed no progression of AIFS. GA was discontinued since the diagnosis, and MS has remained stable. Recognizing this unique group of atrisk patients is crucial, as early detection and treatment play a pivotal role in preventing significant morbidity and mortality.","PeriodicalId":42462,"journal":{"name":"Precision and Future Medicine","volume":"57 6","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139132311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Seong-Joon Lee, Yoon Seob Kim, Jin Soo Lee, Ji Man Hong
A 70-year-old male with risk factors for vascular disease presented with dizziness and instability. The patient showed horizontal geotropic nystagmus when turning his head while lying down, with larger slow phase velocity observed when turning to the left. There were no other neurological deficits. Video head impulse tests and vestibular evoked myogenic potentials were normal. The initial magnetic resonance imaging (MRI) findings were negative; however, the patient experienced subsequent right-side weakness, right tilting, and recurrent episodes of vertigo. A follow-up MRI revealed an acute left medial medullary infarction, which seems to have caused the paroxysmal geotropic central positional nystagmus in this patient.
{"title":"Central positional nystagmus due to acute medial medullary infarction","authors":"Seong-Joon Lee, Yoon Seob Kim, Jin Soo Lee, Ji Man Hong","doi":"10.23838/pfm.2023.00093","DOIUrl":"https://doi.org/10.23838/pfm.2023.00093","url":null,"abstract":"A 70-year-old male with risk factors for vascular disease presented with dizziness and instability. The patient showed horizontal geotropic nystagmus when turning his head while lying down, with larger slow phase velocity observed when turning to the left. There were no other neurological deficits. Video head impulse tests and vestibular evoked myogenic potentials were normal. The initial magnetic resonance imaging (MRI) findings were negative; however, the patient experienced subsequent right-side weakness, right tilting, and recurrent episodes of vertigo. A follow-up MRI revealed an acute left medial medullary infarction, which seems to have caused the paroxysmal geotropic central positional nystagmus in this patient.","PeriodicalId":42462,"journal":{"name":"Precision and Future Medicine","volume":"34 11","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136281460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ju Yeon Bae, Hansol Kim, Seon Young Kim, So Yeong Yoo, Tae Yeon Jeon, Inwoo Hwang, Soomin Ahn, Yon Ho Choe, Mi Jin Kim, Yoon Zi Kim
Crohn’s disease (CD) is a type of inflammatory bowel disease (IBD) characterized by chronic granulomatous inflammation of any part of the body, primarily the gastrointestinal (GI) tract, and is increasing in incidence worldwide. As CD is a systemic disease, the features of CD typically manifest in the GI tract; however, a variety of extra-intestinal manifestations, such as the involvement of joints, skin, and eyes may also occur. Although pyogenic liver abscess itself is rare in the general population (approximately 3–5 per 100,000 hospital admissions), it is also an unusual and rare presentation in pediatric CD patients. In this report, we present a case of pyogenic liver abscess in a 7-year-old female CD patient and discuss the clinical features, laboratory findings, imaging studies, and pathologic report of liver biopsy.
{"title":"Pyogenic liver abscess as an extra-intestinal manifestation of pediatric Crohn’s disease","authors":"Ju Yeon Bae, Hansol Kim, Seon Young Kim, So Yeong Yoo, Tae Yeon Jeon, Inwoo Hwang, Soomin Ahn, Yon Ho Choe, Mi Jin Kim, Yoon Zi Kim","doi":"10.23838/pfm.2023.00135","DOIUrl":"https://doi.org/10.23838/pfm.2023.00135","url":null,"abstract":"Crohn’s disease (CD) is a type of inflammatory bowel disease (IBD) characterized by chronic granulomatous inflammation of any part of the body, primarily the gastrointestinal (GI) tract, and is increasing in incidence worldwide. As CD is a systemic disease, the features of CD typically manifest in the GI tract; however, a variety of extra-intestinal manifestations, such as the involvement of joints, skin, and eyes may also occur. Although pyogenic liver abscess itself is rare in the general population (approximately 3–5 per 100,000 hospital admissions), it is also an unusual and rare presentation in pediatric CD patients. In this report, we present a case of pyogenic liver abscess in a 7-year-old female CD patient and discuss the clinical features, laboratory findings, imaging studies, and pathologic report of liver biopsy.","PeriodicalId":42462,"journal":{"name":"Precision and Future Medicine","volume":"126 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135818817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yoon Ji Ahn, Dasom Park, Mi Jin Kim, Yon Ho Choe, Youngse Kwon, Yiyoung Kwon
Leukemia and Crohn’s disease are both diseases that can be influenced by genetic factors. Tuberous sclerosis complex (TSC) is a rare autosomal dominant neurogenetic disorder caused by genetic mutation. This report presents a pediatric case of concomitant development of leukemia, Crohn’s disease, and TSC. We aimed to study the pathogenesis of each disease and report this case to provide data for future reports and research on correlation of these three diseases.
{"title":"Co-occurrence of leukemia, Crohn’s disease, and tuberous sclerosis in one patient","authors":"Yoon Ji Ahn, Dasom Park, Mi Jin Kim, Yon Ho Choe, Youngse Kwon, Yiyoung Kwon","doi":"10.23838/pfm.2023.00128","DOIUrl":"https://doi.org/10.23838/pfm.2023.00128","url":null,"abstract":"Leukemia and Crohn’s disease are both diseases that can be influenced by genetic factors. Tuberous sclerosis complex (TSC) is a rare autosomal dominant neurogenetic disorder caused by genetic mutation. This report presents a pediatric case of concomitant development of leukemia, Crohn’s disease, and TSC. We aimed to study the pathogenesis of each disease and report this case to provide data for future reports and research on correlation of these three diseases.","PeriodicalId":42462,"journal":{"name":"Precision and Future Medicine","volume":"24 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135876618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Long bone growth is a fundamental determinant of final height. Growth, metabolism, and differentiation of chondrocytes, which are the key cellular players in this process, are regulated by systemic hormones, local factors, and cellular signaling pathways. This review provides an overview of the structural aspects of the growth plate, factors influencing chondrocyte function, and their impact on longitudinal bone growth. Systemic factors, including growth hormone, sex hormones, thyroid hormone, glucocorticoids, leptin, and insulin significantly affect chondrocyte proliferation and hypertrophy. Local factors, including transcription factors such as SRY-box 9 protein (SOX9), Runt-related transcription factor 2 (RUNX2), and bone morphogenetic proteins (BMPs), along with signaling pathways such as the Wnt pathway, play critical roles in chondrocyte proliferation and differentiation. These factors regulate gene expression, cell differentiation, and extracellular matrix synthesis. Additionally, Indian hedgehog (Ihh) and C-type natriuretic peptide (CNP) are involved in the complex signaling network governing chondrocyte function. Understanding molecular mechanisms underlying normal growth plate function has provided valuable insights into the genetic defects that impact growth and foundation for the development of effective therapeutic strategies for individuals with growth disorders.
{"title":"Molecular mechanisms of long bone growth and chondrocyte regulation: A narrative review","authors":"Eungu Kang","doi":"10.23838/pfm.2023.00100","DOIUrl":"https://doi.org/10.23838/pfm.2023.00100","url":null,"abstract":"Long bone growth is a fundamental determinant of final height. Growth, metabolism, and differentiation of chondrocytes, which are the key cellular players in this process, are regulated by systemic hormones, local factors, and cellular signaling pathways. This review provides an overview of the structural aspects of the growth plate, factors influencing chondrocyte function, and their impact on longitudinal bone growth. Systemic factors, including growth hormone, sex hormones, thyroid hormone, glucocorticoids, leptin, and insulin significantly affect chondrocyte proliferation and hypertrophy. Local factors, including transcription factors such as SRY-box 9 protein (SOX9), Runt-related transcription factor 2 (RUNX2), and bone morphogenetic proteins (BMPs), along with signaling pathways such as the Wnt pathway, play critical roles in chondrocyte proliferation and differentiation. These factors regulate gene expression, cell differentiation, and extracellular matrix synthesis. Additionally, Indian hedgehog (Ihh) and C-type natriuretic peptide (CNP) are involved in the complex signaling network governing chondrocyte function. Understanding molecular mechanisms underlying normal growth plate function has provided valuable insights into the genetic defects that impact growth and foundation for the development of effective therapeutic strategies for individuals with growth disorders.","PeriodicalId":42462,"journal":{"name":"Precision and Future Medicine","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136276710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ji Hyun Baek, Sun Jae Jung, Amy Peters, Alpdogan Kantarci, Andrew A. Nierenberg
Chronic low-grade inflammation plays a role in the pathophysiology of bipolar disorder. Recent studies have shown that periodontitis can affect the central nervous system by activating inflammatory mediators in the brain. However, only a few studies have examined the association between periodontitis and bipolar disorder. Here, we aimed to review the current evidence on the association between periodontal diseases and bipolar disorder, its potential mechanisms, and future research directions. Studies so far suggested that periodontal diseases were more common in patients with bipolar disorder than in the general population. Patients with bipolar disorder generally have poor oral hygiene owing to poor self-care, smoking, alcohol abuse, and the effects of psychotropic medications. Proposed mechanisms underlying this association include the effects of inflammatory mediators, direct invasion of oral microbiota, modulation of the neurotransmitter system, and impact on the vagus nerve and hypothalamus-pituitary- adrenal axis. Additional clinical studies examining the prevalence of periodontal diseases and their association with the clinical features of bipolar disorder are necessary. Clinical studies targeting the treatment of periodontal diseases for primary or secondary prevention of bipolar disorder are warranted.
{"title":"Association between periodontal diseases and bipolar disorder: implications for therapeutic interventions: A narrative review","authors":"Ji Hyun Baek, Sun Jae Jung, Amy Peters, Alpdogan Kantarci, Andrew A. Nierenberg","doi":"10.23838/pfm.2023.00086","DOIUrl":"https://doi.org/10.23838/pfm.2023.00086","url":null,"abstract":"Chronic low-grade inflammation plays a role in the pathophysiology of bipolar disorder. Recent studies have shown that periodontitis can affect the central nervous system by activating inflammatory mediators in the brain. However, only a few studies have examined the association between periodontitis and bipolar disorder. Here, we aimed to review the current evidence on the association between periodontal diseases and bipolar disorder, its potential mechanisms, and future research directions. Studies so far suggested that periodontal diseases were more common in patients with bipolar disorder than in the general population. Patients with bipolar disorder generally have poor oral hygiene owing to poor self-care, smoking, alcohol abuse, and the effects of psychotropic medications. Proposed mechanisms underlying this association include the effects of inflammatory mediators, direct invasion of oral microbiota, modulation of the neurotransmitter system, and impact on the vagus nerve and hypothalamus-pituitary- adrenal axis. Additional clinical studies examining the prevalence of periodontal diseases and their association with the clinical features of bipolar disorder are necessary. Clinical studies targeting the treatment of periodontal diseases for primary or secondary prevention of bipolar disorder are warranted.","PeriodicalId":42462,"journal":{"name":"Precision and Future Medicine","volume":"92 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136276715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
As the overall survival of patients with cancer has increased over the past decade, the need for bronchoscopic intervention to resolve malignant central airway obstruction (MCAO) has correspondingly increased. The response to chemotherapy and radiotherapy is slow and cannot be guaranteed to adequately address MCAO. Surgery is often impossible because of the extent of disease or the poor performance status of patients. Bronchoscopic intervention results in immediate therapeutic response and is considered safe. Accordingly, many interventional pulmonologists and oncologists are interested in this field, but it is challenging and detailed techniques are not properly standardized, which are barriers to entry into this field. This review aimed to explore the indications and clinical applications of bronchoscopic intervention for patients with MCAO using previously reported data and representative cases from our pioneering experiences. In particular, we focused on rigid bronchoscopy for MCAO, excluding procedures for fistulas or radiation-induced bronchitis stenosis that occurred secondary to anti-cancer treatment.
{"title":"Rigid bronchoscopic intervention for malignant central airway obstruction: A narrative review","authors":"Byeong-Ho Jeong, Hojoong Kim","doi":"10.23838/pfm.2023.00072","DOIUrl":"https://doi.org/10.23838/pfm.2023.00072","url":null,"abstract":"As the overall survival of patients with cancer has increased over the past decade, the need for bronchoscopic intervention to resolve malignant central airway obstruction (MCAO) has correspondingly increased. The response to chemotherapy and radiotherapy is slow and cannot be guaranteed to adequately address MCAO. Surgery is often impossible because of the extent of disease or the poor performance status of patients. Bronchoscopic intervention results in immediate therapeutic response and is considered safe. Accordingly, many interventional pulmonologists and oncologists are interested in this field, but it is challenging and detailed techniques are not properly standardized, which are barriers to entry into this field. This review aimed to explore the indications and clinical applications of bronchoscopic intervention for patients with MCAO using previously reported data and representative cases from our pioneering experiences. In particular, we focused on rigid bronchoscopy for MCAO, excluding procedures for fistulas or radiation-induced bronchitis stenosis that occurred secondary to anti-cancer treatment.","PeriodicalId":42462,"journal":{"name":"Precision and Future Medicine","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136276712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prader-Willi syndrome (PWS) is a rare genetic disorder characterized by various clinical features linked to hypothalamic/pituitary gland abnormalities. Growth hormone deficiency is a prominent feature of PWS that results in poor linear growth and delayed development. This review discusses the evaluation and effects of growth hormone therapy (GHT) in PWS. Heterogeneity in growth hormone secretion patterns based on genotype and the potential for personalized GHT were explored. The benefits of GHT, including improvements in motor and cognitive development, growth, and body composition, are discussed in detail. Safety considerations for GHT initiation and response to GHT in adults with PWS are discussed, along with ongoing debates regarding the efficacy and safety. Although controversies persist, an evolving understanding of the long-term effects and safety of GHT underscores the need for comprehensive research in this field.
{"title":"Prader-Willi syndrome and growth hormone therapy: exploring the precise management of hypothalamic short stature: A review","authors":"Aram Yang","doi":"10.23838/pfm.2023.00079","DOIUrl":"https://doi.org/10.23838/pfm.2023.00079","url":null,"abstract":"Prader-Willi syndrome (PWS) is a rare genetic disorder characterized by various clinical features linked to hypothalamic/pituitary gland abnormalities. Growth hormone deficiency is a prominent feature of PWS that results in poor linear growth and delayed development. This review discusses the evaluation and effects of growth hormone therapy (GHT) in PWS. Heterogeneity in growth hormone secretion patterns based on genotype and the potential for personalized GHT were explored. The benefits of GHT, including improvements in motor and cognitive development, growth, and body composition, are discussed in detail. Safety considerations for GHT initiation and response to GHT in adults with PWS are discussed, along with ongoing debates regarding the efficacy and safety. Although controversies persist, an evolving understanding of the long-term effects and safety of GHT underscores the need for comprehensive research in this field.","PeriodicalId":42462,"journal":{"name":"Precision and Future Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136276713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Many radiologists and urologists believe that magnetic resonance imaging (MRI) is superior to transrectal ultrasonography (TRUS) in the detection and assessment of prostate cancer. Thus, they relied on MRI alone for tumor characterization. However, the role of TRUS in prostate cancer assessment remains unclear. This information on TRUS findings can aid radiologists and urologists in detecting, targeting, and staging cancers. Additionally, there are some imaging features that are unseen on MRI, but are visible on TRUS. However, few studies have addressed the added value of TRUS in the preoperative evaluation of prostate cancer. This review aimed to assess the added value of TRUS to preoperative MRI for prostate cancer detection, characterization, and staging.
{"title":"Added values of transrectal ultrasonography to magnetic resonance imaging in characterizing prostate cancer: A narrative review","authors":"Byung Kwan Park","doi":"10.23838/pfm.2023.00107","DOIUrl":"https://doi.org/10.23838/pfm.2023.00107","url":null,"abstract":"Many radiologists and urologists believe that magnetic resonance imaging (MRI) is superior to transrectal ultrasonography (TRUS) in the detection and assessment of prostate cancer. Thus, they relied on MRI alone for tumor characterization. However, the role of TRUS in prostate cancer assessment remains unclear. This information on TRUS findings can aid radiologists and urologists in detecting, targeting, and staging cancers. Additionally, there are some imaging features that are unseen on MRI, but are visible on TRUS. However, few studies have addressed the added value of TRUS in the preoperative evaluation of prostate cancer. This review aimed to assess the added value of TRUS to preoperative MRI for prostate cancer detection, characterization, and staging.","PeriodicalId":42462,"journal":{"name":"Precision and Future Medicine","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136276714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Min Kim, Seong-Joon Lee, So-Young Park, Jiman Hong, J. S. Lee
Purpose: Among patients with acute ischemic stroke (AIS), those with intracranial large vessel occlusion (LVO) should undertake endovascular treatment (EVT) based on mechanical thrombectomy. Although the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification system has been used in overall population of patients with AIS, especially for secondary prevention. In the current study, a new classification system for the LVO population is proposed.Methods: The classic TOAST and Stop Stroke Study TOAST (SSS TOAST) were applied to the LVO population. Based on discordance with those systems, a new LVO classification system was developed and applied to the LVO population. The new system comprised extracranial atherosclerosis (ECAS), intracranial atherosclerosis (ICAS), cardioembolism (CE), cryptogenic embolism, stroke of undetermined etiology (SUE; two or more etiologies), and stroke of other determined etiology (SOE) where small artery occlusion was removed.Results: The LVO classification system comprised 43 ECAS (6.52%), 141 ICAS (21.36%), 303 CE (45.91%), 75 cryptogenic embolism (11.36%), 75 SUE (11.36%; cardioembolic source in 98.67%), and 23 SOE (3.48%) patients. The ICAS group had a significantly longer median onset-to-puncture time than the other groups. In the ICAS group, 102 of 141 (72.34%) remained partial recanalization after EVT.Conclusion: The LVO classification system differentiating ECAS and ICAS in patients with large artery atherosclerosis and classifying cryptogenic embolism is more suitable for patients with EVT for intracranial LVO. Further studies for predicting underlying ICAS and planning treatment strategy should be performed.
{"title":"A novel etiological classification in patients with intracranial large vessel occlusion and endovascular treatment: discordance with the classic and SSS TOAST systems: A retrospective cohort study","authors":"Min Kim, Seong-Joon Lee, So-Young Park, Jiman Hong, J. S. Lee","doi":"10.23838/pfm.2023.00065","DOIUrl":"https://doi.org/10.23838/pfm.2023.00065","url":null,"abstract":"Purpose: Among patients with acute ischemic stroke (AIS), those with intracranial large vessel occlusion (LVO) should undertake endovascular treatment (EVT) based on mechanical thrombectomy. Although the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification system has been used in overall population of patients with AIS, especially for secondary prevention. In the current study, a new classification system for the LVO population is proposed.Methods: The classic TOAST and Stop Stroke Study TOAST (SSS TOAST) were applied to the LVO population. Based on discordance with those systems, a new LVO classification system was developed and applied to the LVO population. The new system comprised extracranial atherosclerosis (ECAS), intracranial atherosclerosis (ICAS), cardioembolism (CE), cryptogenic embolism, stroke of undetermined etiology (SUE; two or more etiologies), and stroke of other determined etiology (SOE) where small artery occlusion was removed.Results: The LVO classification system comprised 43 ECAS (6.52%), 141 ICAS (21.36%), 303 CE (45.91%), 75 cryptogenic embolism (11.36%), 75 SUE (11.36%; cardioembolic source in 98.67%), and 23 SOE (3.48%) patients. The ICAS group had a significantly longer median onset-to-puncture time than the other groups. In the ICAS group, 102 of 141 (72.34%) remained partial recanalization after EVT.Conclusion: The LVO classification system differentiating ECAS and ICAS in patients with large artery atherosclerosis and classifying cryptogenic embolism is more suitable for patients with EVT for intracranial LVO. Further studies for predicting underlying ICAS and planning treatment strategy should be performed.","PeriodicalId":42462,"journal":{"name":"Precision and Future Medicine","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47870807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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