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Darbepoetin Alfa in Patients with Advanced CKD without Diabetes: Randomized, Controlled Trial

Background and objectives

Large, randomized, controlled trials targeting higher hemoglobin level with erythropoiesis-stimulating agents for Western patients with CKD showed harm. However, the effect of anemia correction using erythropoiesis-stimulating agents may differ between CKD subpopulations. The Prevention of ESKD by Darbepoetin Alfa in CKD Patients with Non-diabetic Kidney Disease study, a multicenter, randomized, open-label, parallel-group study, aimed to examine the effect of targeting hemoglobin levels of 11–13 g/dl using darbepoetin alfa with reference to a low-hemoglobin target of 9–11 g/dl on kidney outcome in patients with advanced CKD without diabetes in Japan.

Design, setting, participants, & measurements

We enrolled 491 patients with CKD without diabetes, and an eGFR of 8–20 ml/min per 1.73 m2. Of these 491 patients, 239 and 240 were ultimately assigned to the high- and low-hemoglobin groups, respectively (12 patients were excluded). The primary outcome was a kidney composite end point (starting maintenance dialysis, kidney transplantation, eGFR≤6 ml/min per 1.73 m2, and 50% reduction in eGFR).

Results

Mean hemoglobin levels were 11.2±1.1 and 10.0±0.9 g/dl in the high- and low-hemoglobin groups, respectively, during the mean study period of 73.5±29.7 weeks. The kidney composite end point occurred in 105 (44%) and 116 (48%) patients in the high- and low-hemoglobin groups, respectively (log-rank test; P=0.32). The adjusted Cox proportional hazards model showed that the hazard ratio for the high- versus low-hemoglobin group was 0.78 (95% confidence interval, 0.60 to 1.03; P=0.08). Cardiovascular events occurred in 19 (8%) and 16 (7%) patients in each group, respectively, with no significant between-group difference (log-rank test; P=0.66).

Conclusions

Targeting a higher hemoglobin level (11–13 g/dl) with darbepoetin alfa did not improve kidney outcome compared with targeting a lower hemoglobin level (9–11 g/dl) in patients with advanced CKD without diabetes.

Clinical Trial registry name and registration number

Prevention of ESKD by Darbepoetin Alfa in CKD Patients with Non-diabetic Kidney Disease (PREDICT), NCT01581073.




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Single-Cell Immune Competency Signatures Associate with Survival in Phase II GVAX and CRS-207 Randomized Studies in Patients with Metastatic Pancreatic Cancer

The identification of biomarkers for patient stratification is fundamental to precision medicine efforts in oncology. Here, we identified two baseline, circulating immune cell subsets associated with overall survival in patients with metastatic pancreatic cancer who were enrolled in two phase II randomized studies of GVAX pancreas and CRS-207 immunotherapy. Single-cell mass cytometry was used to simultaneously measure 38 cell surface or intracellular markers in peripheral blood mononuclear cells obtained from a phase IIa patient subcohort (N = 38). CITRUS, an algorithm for identification of stratifying subpopulations in multidimensional cytometry datasets, was used to identify single-cell signatures associated with clinical outcome. Patients with a higher abundance of CD8+CD45ROCCR7CD57+ cells and a lower abundance of CD14+CD33+CD85j+ cells had improved overall survival [median overall survival, range (days) 271, 43–1,247] compared with patients with a lower abundance of CD8+CD45ROCCR7CD57+ cells and higher abundance of CD14+CD33+CD85j+ cells (77, 24–1,247 days; P = 0.0442). The results from this prospective–retrospective biomarker analysis were validated by flow cytometry in 200 patients with pancreatic cancer enrolled in a phase IIb study (P = 0.0047). The identified immune correlates provide potential prognostic or predictive signatures that could be employed for patient stratification.




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Correction for Pozsgai et al., "Modified mariner Transposons for Random Inducible-Expression Insertions and Transcriptional Reporter Fusion Insertions in Bacillus subtilis" [Author Correction]




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A novel decision aid to help plan for serious illness: a multisite randomized trial

Background:

Recent studies have shown substantial deficiencies in the quality or quantity (or both) of communication and decision-making during serious illness. We evaluated the efficacy of a novel decision support intervention, the Plan Well Guide, in increasing completion of a standard medical order form for advance medical care planning and improving decisional outcomes in nonacademic primary care settings.

Methods:

We conducted a randomized trial in 3 primary care practices in Lethbridge, Alberta in 2017–2018. We recruited "patients at high risk" referred by the primary care doctor who required establishment or review of their Goals of Care Designation (GCD). Enrolled patients were randomly allocated to receive the Plan Well Guide, delivered by a trained facilitator, or usual care. Eight to 12 weeks after the intervention, a research assistant blinded to intervention assignment contacted the patients in both groups by telephone to do a final outcome assessment. The primary outcome was completion of GCD forms; secondary outcomes included decisional conflict scores and ratings of satisfaction.

Results:

A total of 123 patients (59 women [48.0%]; mean age 73.9 yr) were enrolled, 66 in the intervention arm and 57 in the usualcare arm; 119 patients completed the trial. After the intervention, GCD completion rates in the intervention and usual-care groups were 95.3% and 90.9%, respectively (risk difference [RD] 4%, 95% confidence interval [CI] –14% to 22%), and the rate of concordance between medical orders and expressed preferences on follow-up was 78% and 66%, respectively (RD 12%, 95% CI –7% to 30%). Significantly fewer patients in the intervention group than in the usual-care group had written medical orders for intensive care unit care and cardiopulmonary resuscitation (22 [34%] v. 33 [60%], RD –26%, 95% CI –42% to –8%). Patients in the intervention group had lower decisional conflict scores than those in the usual-care group (mean 30.9 v. 43.1, adjusted mean difference –12.0, 95% CI –23.2 to –0.8). Physicians considered patients in the intervention group to have lower decisional conflict than those in the usual-care group, although not significantly so (mean score 10.4 v. 14.9, adjusted mean difference –4.7, 95% CI –9.9 to 0.4) and spent less time with the former (mean 9.7 v. 13.2 min, adjusted mean difference –3.5, 95% CI –5.5 to –1.5 min).

Interpretation:

The decision-support intervention did not increase GCD completion rates but did seem to improve some aspects of decisional quality while reducing the physician’s time to accomplish GCD decisions. Trial registration: ClinicalTrials.gov, no. NCT01297946




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25-Hydroxyvitamin D and Risk of Osteoporotic Fractures: Mendelian Randomization Analysis in 2 Large Population-Based Cohorts

Abstract
Background
Whether low plasma 25-hydroxyvitamin D concentrations cause osteoporotic fractures is unclear. We tested the hypothesis that low plasma 25-hydroxyvitamin D concentrations are associated with increased risk of osteoporotic fractures using a Mendelian randomization analysis.
Methods
We genotyped 116 335 randomly chosen white Danish persons aged 20–100 years in 2 population-based cohort studies for plasma 25-hydroxyvitamin D decreasing genotypes in CYP2R1 (rs117913124 and rs12794714), DHCR7 (rs7944926 and rs11234027), GEMIN2 (rs2277458), and HAL (rs3819817); 35 833 had information on plasma 25-hydroxyvitamin D. We assessed risk of total, osteoporotic, and anatomically localized fractures from 1981 through 2017. Information on fractures and vital status was obtained from nationwide registries.
Results
During up to 36 years of follow-up, we observed 17 820 total fractures, 10 861 osteoporotic fractures, and 3472 fractures of hip or femur. Compared with individuals with 25-hydroxyvitamin D ≥ 50nmol/L, multivariable adjusted hazard ratios (95% CIs) for total fractures were 1.03 (0.97–1.09) for individuals with 25–49.9 nmol/L, 1.19 (1.10–1.28) for individuals with 12.5–24.9 nmol/L, and 1.39 (1.21–1.60) for individuals with 25-hydroxyvitamin D < 12.5 nmol/L. Corresponding hazard ratios were 1.07 (1.00–1.15), 1.25 (1.13–1.37), and 1.49 (1.25–1.77) for osteoporotic fractures and 1.09 (0.98–1.22), 1.37 (1.18–1.57), and 1.41 (1.09–1.81) for fractures of hip or femur, respectively. Hazard ratios per 1 increase in vitamin D allele score, corresponding to 3.0% (approximately 1.6 nmol/L) lower 25-hydroxyvitamin D concentrations, were 0.99 (0.98–1.00) for total fractures, 0.99 (0.97–1.00) for osteoporotic fractures, and 0.98 (0.95–1.00) for fractures of hip or femur.
Conclusions
Low plasma 25-hydroxyvitamin D concentrations were associated with osteoporotic fractures; however, Mendelian randomization analysis provided no evidence supporting a causal role for vitamin D in the risk for osteoporotic fractures.




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Overdiagnosis of lung cancer with low-dose computed tomography screening: meta-analysis of the randomised clinical trials

In low-dose computed tomography (LDCT) screening for lung cancer, all three main conditions for overdiagnosis in cancer screening are present: 1) a reservoir of slowly or nongrowing lung cancer exists; 2) LDCT is a high-resolution imaging technology with the potential to identify this reservoir; and 3) eligible screening participants have a high risk of dying from causes other than lung cancer. The degree of overdiagnosis in cancer screening is most validly estimated in high-quality randomised controlled trials (RCTs), with enough follow-up time after the end of screening to avoid lead-time bias and without contamination of the control group.

Nine RCTs investigating LDCT screening were identified. Two RCTs were excluded because lung cancer incidence after the end of screening was not published. Two other RCTs using active comparators were also excluded. Therefore, five RCTs were included: two trials were at low risk of bias, two of some concern and one at high risk of bias. In a meta-analysis of the two low risk of bias RCTs including 8156 healthy current or former smokers, 49% of the screen-detected cancers were overdiagnosed. There is uncertainty about this substantial degree of overdiagnosis due to unexplained heterogeneity and low precision of the summed estimate across the two trials.

Key points

  • Nine randomised controlled trials (RCTs) on low-dose computed tomography screening were identified; five were included for meta-analysis but only two of those were at low risk of bias.

  • In a meta-analysis of recent low risk of bias RCTs including 8156 healthy current or former smokers from developed countries, we found that 49% of the screen-detected cancers may be overdiagnosed.

  • There is uncertainty about the degree of overdiagnosis in lung cancer screening due to unexplained heterogeneity and low precision of the point estimate.

  • If only high-quality RCTs are included in the meta-analysis, the degree of overdiagnosis is substantial.

  • Educational aims

  • To appreciate that low-dose computed tomography screening for lung cancer meets all three main conditions for overdiagnosis in cancer screening: a reservoir of indolent cancers exists in the population; the screening test is able to "tap" this reservoir by detecting biologically indolent cancers as well as biologically important cancers; and the population being screened is characterised by a relatively high competing risk of death from other causes

  • To learn about biases that might affect the estimates of overdiagnosis in randomised controlled trials in cancer screening




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    "ERS International Congress 2019: highlights from Best Abstract awardees". Lorna E. Latimer, Marieke Duiverman, Mahmoud I. Abdel-Aziz, Gulser Caliskan, Sara M. Mensink-Bout, Alberto Mendoza-Valderrey, Aurelien Justet, Junichi Omura, Karthi Srika




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    Efficacy and Safety of Pembrolizumab in Previously Treated Advanced Neuroendocrine Tumors: Results From the Phase II KEYNOTE-158 Study

    Purpose:

    KEYNOTE-158 (ClinicalTrials.gov identifier: NCT02628067) investigated the efficacy and safety of pembrolizumab across multiple cancers. We present results from patients with previously treated advanced well-differentiated neuroendocrine tumors (NET).

    Patients and Methods:

    Pembrolizumab 200 mg was administered every 3 weeks for 2 years or until progression, intolerable toxicity, or physician/patient decision. Tumor imaging was performed every 9 weeks for the first year and then every 12 weeks. Endpoints included objective response rate (ORR) per RECIST v1.1 by independent central radiologic review (primary) and duration of response (DOR), progression-free survival (PFS), overall survival (OS), and safety (secondary).

    Results:

    A total of 107 patients with NETs of the lung, appendix, small intestine, colon, rectum, or pancreas were treated. Median age was 59.0 years (range, 29–80), 44.9% had ECOG performance status 1, 40.2% had received ≥3 prior therapies for advanced disease, and 15.9% had PD-L1–positive tumors (combined positive score ≥1). Median follow-up was 24.2 months (range, 0.6–33.4). ORR was 3.7% (95% CI, 1.0–9.3), with zero complete responses and four partial responses (three pancreatic and one rectal) all in patients with PD-L1–negative tumors. Median DOR was not reached, with one of four responses ongoing after ≥21 months follow-up. Median PFS was 4.1 months (95% CI, 3.5–5.4); the 6-month PFS rate was 39.3%. Median OS was 24.2 months (95% CI, 15.8–32.5). Treatment-related adverse events (AE) occurred in 75.7% of patients, 21.5% of whom had grade 3–5 AEs.

    Conclusions:

    Pembrolizumab monotherapy showed limited antitumor activity and manageable safety in patients with previously treated advanced well-differentiated NETs.




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    Novel Endochin-Like Quinolones Exhibit Potent In Vitro Activity against Plasmodium knowlesi but Do Not Synergize with Proguanil [Susceptibility]

    Quinolones, such as the antimalarial atovaquone, are inhibitors of the malarial mitochondrial cytochrome bc1 complex, a target critical to the survival of both liver- and blood-stage parasites, making these drugs useful as both prophylaxis and treatment. Recently, several derivatives of endochin have been optimized to produce novel quinolones that are active in vitro and in animal models. While these quinolones exhibit potent ex vivo activity against Plasmodium falciparum and Plasmodium vivax, their activity against the zoonotic agent Plasmodium knowlesi is unknown. We screened several of these novel endochin-like quinolones (ELQs) for their activity against P. knowlesi in vitro and compared this with their activity against P. falciparum tested under identical conditions. We demonstrated that ELQs are potent against P. knowlesi (50% effective concentration, <117 nM) and equally effective against P. falciparum. We then screened selected quinolones and partner drugs using a longer exposure (2.5 life cycles) and found that proguanil is 10-fold less potent against P. knowlesi than P. falciparum, while the quinolones demonstrate similar potency. Finally, we used isobologram analysis to compare combinations of the ELQs with either proguanil or atovaquone. We show that all quinolone combinations with proguanil are synergistic against P. falciparum. However, against P. knowlesi, no evidence of synergy between proguanil and the quinolones was found. Importantly, the combination of the novel quinolone ELQ-300 with atovaquone was synergistic against both species. Our data identify potentially important species differences in proguanil susceptibility and in the interaction of proguanil with quinolones and support the ongoing development of novel quinolones as potent antimalarials that target multiple species.




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    Synergistic Interactions of Indole-2-Carboxamides and {beta}-Lactam Antibiotics against Mycobacterium abscessus [Mechanisms of Action]

    New drugs or therapeutic combinations are urgently needed against Mycobacterium abscessus. Previously, we demonstrated the potent activity of indole-2-carboxamides 6 and 12 against M. abscessus. We show here that these compounds act synergistically with imipenem and cefoxitin in vitro and increase the bactericidal activity of the β-lactams against M. abscessus. In addition, compound 12 also displays synergism with imipenem and cefoxitin within infected macrophages. The clinical potential of these new drug combinations requires further evaluation.




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    Tedizolid as Step-Down Therapy following Daptomycin versus Continuation of Daptomycin against Enterococci and Methicillin- and Vancomycin-Resistant Staphylococcus aureus in a Rat Endocarditis Model [Experimental Therapeutics]

    Tedizolid (TZD) and daptomycin (DAP) were assessed in a rat endocarditis model against Enterococcus faecalis, Enterococcus faecium (resistant to vancomycin and ampicillin), and Staphylococcus aureus. As a monotherapy, TZD for 5 days was not effective in a comparison with no-treatment controls, while DAP for 5 days was significantly effective against these bacteria. Step-down therapy (DAP for 3 days followed by TZD for 2 days) was as effective as DAP for 5 days and was comparable to 3 days of DAP plus ceftriaxone against all bacteria and to 3 days of DAP plus gentamicin against E. faecalis OG1RF.




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    Defining an embryonal rhabdomyosarcoma endotype [RESEARCH ARTICLE]

    Rhabdomyosarcoma (RMS) is the most common childhood soft-tissue sarcoma. The largest subtype of RMS is embryonal rhabdomyosarcoma (ERMS) and accounts for 53% of all RMS. ERMS typically occurs in the head and neck region, bladder, or reproductive organs and portends a promising prognosis when localized; however, when metastatic the 5-yr overall survival rate is ~43%. The genomic landscape of ERMS demonstrates a range of putative driver mutations, and thus the recognition of the pathological mechanisms driving tumor maintenance should be critical for identifying effective targeted treatments at the level of the individual patients. Here, we report genomic, phenotypic, and bioinformatic analyses for a case of a 3-yr-old male who presented with bladder ERMS. Additionally, we use an unsupervised agglomerative clustering analysis of RNA and whole-exome sequencing data across ERMS and undifferentiated pleomorphic sarcoma (UPS) tumor samples to determine several major endotypes inferring potential targeted treatments for a spectrum of pediatric ERMS patient cases.




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    Comparative single-cell RNA sequencing (scRNA-seq) reveals liver metastasis-specific targets in a patient with small intestinal neuroendocrine cancer [RESEARCH REPORT]

    Genomic analysis of a patient's tumor is the cornerstone of precision oncology, but it does not address whether metastases should be treated differently. Here we tested whether comparative single-cell RNA sequencing (scRNA-seq) of a primary small intestinal neuroendocrine tumor to a matched liver metastasis could guide the treatment of a patient's metastatic disease. Following surgery, the patient was put on maintenance treatment with a somatostatin analog. However, the scRNA-seq analysis revealed that the neuroendocrine epithelial cells in the liver metastasis were less differentiated and expressed relatively little SSTR2, the predominant somatostatin receptor. There were also differences in the tumor microenvironments. RNA expression of vascular endothelial growth factors was higher in the primary tumor cells, reflected by an increased number of endothelial cells. Interestingly, vascular expression of the major VEGF receptors was considerably higher in the liver metastasis, indicating that the metastatic vasculature may be primed for expansion and susceptible to treatment with angiogenesis inhibitors. The patient eventually progressed on Sandostatin, and although consideration was given to adding an angiogenesis inhibitor to her regimen, her disease progression involved non-liver metastases that had not been characterized. Although in this specific case comparative scRNA-seq did not alter treatment, its potential to help guide therapy of metastatic disease was clearly demonstrated.




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    Lipid Trait Variants and the Risk of Non-Hodgkin Lymphoma Subtypes: A Mendelian Randomization Study

    Background:

    Lipid traits have been inconsistently linked to risk of non-Hodgkin lymphoma (NHL). We examined the association of genetically predicted lipid traits with risk of diffuse large B-cell lymphoma (DLBCL), chronic lymphocytic leukemia (CLL), follicular lymphoma (FL), and marginal zone lymphoma (MZL) using Mendelian randomization (MR) analysis.

    Methods:

    Genome-wide association study data from the InterLymph Consortium were available for 2,661 DLBCLs, 2,179 CLLs, 2,142 FLs, 824 MZLs, and 6,221 controls. SNPs associated (P < 5 x 10–8) with high-density lipoprotein (HDL, n = 164), low-density lipoprotein (LDL, n = 137), total cholesterol (TC, n = 161), and triglycerides (TG, n = 123) were used as instrumental variables (IV), explaining 14.6%, 27.7%, 16.8%, and 12.8% of phenotypic variation, respectively. Associations between each lipid trait and NHL subtype were calculated using the MR inverse variance–weighted method, estimating odds ratios (OR) per standard deviation and 95% confidence intervals (CI).

    Results:

    HDL was positively associated with DLBCL (OR = 1.14; 95% CI, 1.00–1.30) and MZL (OR = 1.09; 95% CI, 1.01–1.18), while TG was inversely associated with MZL risk (OR = 0.90; 95% CI, 0.83–0.99), all at nominal significance (P < 0.05). A positive trend was observed for HDL with FL risk (OR = 1.08; 95% CI, 0.99–1.19; P = 0.087). No associations were noteworthy after adjusting for multiple testing.

    Conclusions:

    We did not find evidence of a clear or strong association of these lipid traits with the most common NHL subtypes. While these IVs have been previously linked to other cancers, our findings do not support any causal associations with these NHL subtypes.

    Impact:

    Our results suggest that prior reported inverse associations of lipid traits are not likely to be causal and could represent reverse causality or confounding.




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    Race May Not Impact Endocrine Therapy-Related Changes in Breast Density

    Background:

    Reduction in breast density may be a biomarker of endocrine therapy (ET) efficacy. Our objective was to assess the impact of race on ET-related changes in volumetric breast density (VBD).

    Methods:

    This retrospective cohort study assessed longitudinal changes in VBD measures in women with estrogen receptor–positive invasive breast cancer treated with ET. VBD, the ratio of fibroglandular volume (FGV) to breast volume (BV), was measured using Volpara software. Changes in measurements were evaluated using a multivariable linear mixed effects model.

    Results:

    Compared with white women (n = 191), black women (n = 107) had higher rates of obesity [mean ± SD body mass index (BMI) 34.5 ± 9.1 kg/m2 vs. 30.6 ± 7.0 kg/m2, P < 0.001] and premenopausal status (32.7% vs. 16.7%, P = 0.002). Age- and BMI-adjusted baseline FGV, BV, and VBD were similar between groups. Modeled longitudinal changes were also similar: During a follow-up of 30.7 ± 15.0 months (mean ± SD), FGV decreased over time in premenopausal women (slope = –0.323 cm3; SE = 0.093; P = 0.001), BV increased overall (slope = 2.475 cm3; SE = 0.483; P < 0.0001), and VBD decreased (premenopausal slope = –0.063%, SE = 0.011; postmenopausal slope = –0.016%, SE = 0.004; P < 0.0001). Race was not significantly associated with these longitudinal changes, nor did race modify the effect of time on these changes. Higher BMI was associated with lower baseline VBD (P < 0.0001). Among premenopausal women, VBD declined more steeply for women with lower BMI (time x BMI, P = 0.0098).

    Conclusions:

    Race does not appear to impact ET-related longitudinal changes in VBD.

    Impact:

    Racial disparities in estrogen receptor–positive breast cancer recurrence and mortality may not be explained by differential declines in breast density due to ET.




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    Treatment Outcomes of Endovascular Embolization Only in Patients with Unruptured Brain Arteriovenous Malformations: A Subgroup Analysis of ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations) [INTERVENTIONAL]

    BACKGROUND AND PURPOSE:

    Endovascular embolization only has been advocated for treatment of brain arteriovenous malformations in recent trials. Our aim was to evaluate the results of embolization only in a cohort of patients who were enrolled in the A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) study at 39 clinical sites in 9 countries.

    MATERIALS AND METHODS:

    We analyzed the rates and severity of stroke and death in patients who underwent embolization only. Events were identified through in-person neurologic follow-up visits performed at 6-month intervals during the first 2 years and annually, with telephone contact every 6 months thereafter. All event-related data were reviewed by independent adjudicators.

    RESULTS:

    Among 30 patients who had embolization planned, 26 underwent embolization only. A total of 13 stroke events were reported in the follow-up period among 26 subjects (ischemic, hemorrhagic, or both in 4, 7, and 2 subjects, respectively). The adverse event occurred after the first embolization in 11 of 13 patients. One patient had a major motor deficit, and 2 patients developed major visual field deficits. One event was fatal. The modified Rankin Scale score was 0–2 at last follow-up in 11 of the 12 stroke survivors. Estimated stroke-free survival was 46% at 12 months.

    CONCLUSIONS:

    Although the rates of stroke and/or death were high in patients treated with embolization only in ARUBA, the rates of favorable outcomes following stroke were high during follow-up.




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    Complications of Endovascular Treatments for Brain Arteriovenous Malformations: A Nationwide Surveillance [INTERVENTIONAL]

    BACKGROUND AND PURPOSE:

    Embolization is widely performed to treat brain arteriovenous malformations, but little has been reported on factors contributing to complications. We retrospectively reviewed a nationwide surveillance to identify risk factors contributing to complications and short-term clinical outcomes in the endovascular treatment of brain arteriovenous malformations.

    MATERIALS AND METHODS:

    Data for endovascular treatment of brain arteriovenous malformations were extracted from the Japanese nationwide surveillance. Patient characteristics, brain arteriovenous malformation features, procedures, angiographic results, complications, and clinical outcomes at 30 days postprocedure were analyzed.

    RESULTS:

    A total of 1042 endovascular procedures (788 patients; mean, 1.43 ± 0.85 procedures per patient) performed in 111 institutions from 2010 to 2014 were reviewed. Liquid materials were used in 976 procedures (93.7%): to perform presurgical embolization in 638 procedures (61.2%), preradiosurgical embolization in 160 (15.4%), and as sole endovascular treatment in 231 (22.2%). Complete or near-complete obliteration of brain arteriovenous malformations was obtained in 386 procedures (37.0%). Procedure-related complications occurred in 136 procedures (13.1%), including hemorrhagic complications in 59 (5.7%) and ischemic complications in 57 (5.5%). Univariate analysis identified deep venous drainage, associated aneurysms, infratentorial location, and preradiosurgical embolization as statistically significant risk factors for complications. Multivariate analysis showed that embolization of brain arteriovenous malformations in the infratentorial location was significantly associated with complications. Patients with complications due to endovascular procedures had worse clinical outcomes 30 days after the procedures than those without complications.

    CONCLUSIONS:

    Complications arising after endovascular treatment of brain arteriovenous malformations are not negligible even though they may play a role in adjunctive therapy, especially in the management of infratentorial brain arteriovenous malformations.




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    Glasgow Coma Scale on Presentation Predicts Outcome in Endovascular Treatment for Acute Posterior Large-Vessel Occlusion [INTERVENTIONAL]

    SUMMARY:

    Use of mechanical thrombectomy for stroke has increased since the publication of trials describing outcome improvement when used in the anterior circulation. These results, however, cannot be directly translated to the posterior circulation. While a high NIHSS score has demonstrated an association with poor outcomes in posterior stroke, the NIHSS is weighted toward hemispheric disease, and complex scores potentially delay definitive imaging diagnosis. We performed a retrospective analysis to ascertain whether any rapidly obtainable demographic or clinical and imaging data have a correlation with patient outcome postthrombectomy. Seventy-three cases were audited between September 2010 and October 2017. Presenting with a Glasgow Coma Scale score of >13 meant that the odds of reaching the primary end point of functional independence (defined as a 90-day modified Rankin Scale score of 0–2) were 5.70 times greater; similarly, presenting with a posterior circulation ASPECTS of >9 resulted in the odds of reaching the primary end point being 4.03 times greater. Older age correlated to a lower odds of independence (0.97, p = .04).




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    Luxury condo at Garden City, basic furniture, now available

    If you are looking for a quiet, convenient living environment that is close to Hanoi center, this condominium is your best choice. The condo has southwest-facing door and north-facing window, comprising a living room, a kitchen, two bedrooms, two bathrooms and a private yard, cr...




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    Wyndham Soleil - One-bedroom condo for sale in Danang

    Wyndham Soleil Danang is a four-tower complex consisting of one hotel and three condotel buildings meeting five-star standards in the 50-57 storeys range. When completed, Wyndham Soleil Danang will be an iconic Landmark in Danang City. Soliel invites investors to experience luxur...




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    One-bedroom condotel for sale in Wyndham Soleil Project - Danang City - Call 0935 38 48 27

    One-bedroom condotel for sale in Danang City Location: diamond location - four facades - in front of the beach: - North: in Morrison Street - West: in Ho Nghinh Street - South: in Pham Van Dong Street - East: in Vo Nguyen Giap StreetHotline: 0935 38 48 27Wyndham Soleil Danang is ...




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    Wyndham Soleil Danang - one-bedroom condo for sale at only 989k USD

    WYNDHAM SOLEIL DA NANGStudio APARTMENT Construction area: 30.72m2 - 41.78m2 Clearance area: 26.87m2 - 37.14m2 1 Bedroom Apartment Construction area: 60.64m2 - 86.31m2 Carpet area: 54.98m2 - 79.17m2 2 Bedrooms Apartment Construction area: 111.4m2 - 125.7m2 Carpet area: 102.46m2 - ...




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    One Verandah - Condo for sale, 2 bedrooms, SPA 50m2, River View, contact +84 988197791

    - SPA for foreigner - Foreign Developer - River view - Viento Tower - Located in the new administrative area - Easy to reach CBD and surrounding places - 30% paid - Completed handover...




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    THE PARK RESIDENCE 2 BRS 2 WCS CONDO NEX TO VIVO FOR SALE

    * The Park Residence Apartment is next to Vivo City on Nguyen Huu Tho Street, District 7.* Area 66m2: 2 brs, 2 wcs: 2.000.000.000 * Area 94m2: 3 brs, 2 wcs: 2.500.000.000 * Prices above not included VAT, partly furnished, discounted 20%. * Deferred Payment Scheme: only 30% paymen...




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    3 BRS 2 WCS LUXURY ONE VERANDAH CONDO MAPLE TREE FOR SALE

    Luxury ONE VERANDAH Condo Location: Bat Nan Street, Thanh My Loi ward, Dis.2Built by Mapple Tree from SingaporeArea: 107m2, 3 brs + 2 wcs. Price 8.2 ty vnd ( included VAT & 2% Maintenance fee ). Handover fully furnishedStatus: construction completed Utilities: High-class and full...




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    Riverfront condo for sales at Sunwah Pearl - 5 mins to City Center - annual rental yields up to 6%

    PROPERTY DETAILS: - 2BRs on 24th floor - Facing to Saigon river & Saigon Pearl villas - GFA: 106.62 sqm - Selling price: 8,9 billion VND - Estimated rental income: $1,500 monthly ***Rental yields is around 6,7% per year.DEVELOPER: Sunwah Group is a highly diversified conglomerat...




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    My Khang apartment for sale in Phu My Hung, the selling price is 3.55 Billion for 114 sqm condo

    My Khang apartment for sale in Phu My Hung - Area: 114 sqm - 3 bedrooms, 2 bathrooms, fully furnished - Swimming pool view - Selling price: 3.55 Billion VND Please contact us for detail information via 0907 894 503 https://greenhouseagency.vn...




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    Condo with 2BR for sales at Sunwah Pearl - closing to City center - high rental yields +84911130135

    DEVELOPER: Sunwah Group is a highly diversified conglomerate with businesses in seven principal areas: Seafood & Foodstuff, Real Estate, Financial Services, Technology, Media, Infrastructure and Education and training. Activities extend deep into Mainland China as well as to the ...




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    Legal framework for condotels must be completed within this year: PM

    Prime Minister Nguyen Xuan Phuc has just asked the Ministry of Construction (MoC) to promulgate regulations on amendments and supplements to construction standards and rules for condominiums, condotels, resort villas, officetels and rooms for rent.




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    Tòa nhà Văn phòng Eurowindow

    Tọa lạc tại số 2 Tôn Thất Tùng, quận Đống Đa, TP Hà Nội, dự án Tòa nhà văn phòng Eurowindow (Eurowindow Office Building) được đầu tư xây dựng bởi Công ty Cổ phần Đầu tư và xây dựng số 1 Hà Nội (HICC1).




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    8 things home buyers should consider before buying a condo

    Condo is currently the top trend among single-family home buyers as it is a good way to own a home without breaking budget, in addition to various utilities a condo could bring to its owner. For a first-time home buyer, here are 8 things to consider before purchasing a condo if you don't want to regret it later.




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    Landed house vs Condominium – Which one is suitable for you?

    Many people have headaches considering landed house or condominium (condo) for their accommodation choice. By analyzing the pros and cons of each of these types, the infographic below will help you make the right choice.




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    20 questions to ask yourself before buying a condo

    Condo projects are now mushrooming across the country, becoming the favorite choice of most urban residents. However, to choose the right one which will make you satisfy, you need to find answers to the following 20 questions.




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    Condo for rent in Midtown Phu My Hung- Tan Phu Ward-District 7- 112sqm- $1400/ Month

    MIDTOWN PHU MY HUNG-TAN PHU WARD-DISTRICT 7 - River view, a nice house - The house is designed 2 bedrooms. - Area: 112 m2 - Fully furnished, luxury interiors - Near Japanese school, Taipei School, Korea School, supermarket, park, etc. - Rental price $1400/month,this rent can nego...




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    Rental of 1-bedroom condo in Orchard Parkview - Full furniture - Price is only 12 million/month

    Studio with 1 Bedroom Condo for rent in Orchard ParkviewPrice only: 12 million/month- Available now - New 100% + Luxury - Full Furniture................Conntact me: Manh Tuong via Phone, zalo, viber, Whatsapp: 0973 814 788Tks! ...




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    Nhà đầu tư chờ London giảm thuế để “nhảy vào” thị trường bất động sản

    Thay vì xuống tiền ngay để tận dụng lợi thế đồng bảng giảm giá, các nhà đầu tư bất động sản nhắm tới thị trường London nên chờ đợi quyết định giảm thuế có thể được chính phủ Anh công bố vào đầu năm sau để hưởng lợi nhiều hơn.




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    Cần tiền bán gấp căn Emerald 2PN 66.6m2 có Baywindow. Giá mong muốn 2,7 tỷ, thương lượng trực tiếp

    Cần tiền bán gấp căn 66,6m2 2PN có Baywindow phòng ngủ view thoáng đẹp. Block D view kênh 19/5 rộng rãi, dưới là Shophouse của khu cực tiện. Giá: 2.7 tỷ, thương lượng. LH: 0979397902....




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    Corona Commando: पिता की प्रेरणा से मिली ताकत और दो सगी बहनों ने फर्ज को दी प्राथमिकता

    देश सेवा हर नागरिक का पहला कर्तव्य होना चाहिए। बहुत कम लोगों को यह मौका मिलता है। देश सेवा में योगदान देकर अच्छा महसूस कर रही हूं।




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    Artificial leaves made from aluminium could keep windows frost-free

    In winter, the veins of leaves don’t get completely covered in frost. Mimicking this effect could be the best way to create ice-resistant surfaces




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    Smart windows can let visible light through while blocking out heat

    A 3D printed grate can be used to make a smart window that blocks heat from sunlight out in the summer while letting it through in the winter, conserving energy




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    Somebody Is Furiously Uploading '90s Windows Desktop Themes to the Internet Archive

    Please, I implore you: jump on this bandwagon.




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    Alison Roman Bashed Marie Kondo and Chrissy Teigen, and It Did Not Spark Joy

    Photo Illustration by Lyne Lucien/The Daily Beast/Getty

    Alison Roman’s latest comments about Marie Kondo have not sparked joy.

    In an interview with The New Consumer about her increased popularity and the avenues she might pursue to capitalize on it, the popular food columnist discussed her hesitance to put her name on a product line—citing the Japanese organization maven and Chrissy Teigen as examples of what she did not foresee in her own future.

    “I have a collaboration coming out with [the cookware startup] Material, a capsule collection,” Roman said. “It’s limited edition, a few tools that I designed that are based on tools that I use that aren’t in production anywhere—vintage spoons and very specific things that are one-offs that I found at antique markets that they have made for me.”

    Read more at The Daily Beast.




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    Stochastic Robots Use Randomness to Achieve More Complex Goals

    Little swarm robots that can't do much on their own can use their random behavior to accomplish tasks like locomotion




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    Video Friday: Robotic Endoscope Travels Through the Colon

    Your weekly selection of awesome robot videos




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    California Gov. Newsom Endorses Biden, Despite Attempts to Avoid Partisan Politics

    "I just couldn't be more proud of you and the prospect of your presidency," Newsom told Biden Friday during a campaign event.




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    Chrissy Teigen Responds to Alison Roman's Digs at Her and Marie Kondo: 'This is a Huge Bummer'

    Jameela Jamil also came to Teigen and Kondo's defense, calling Roman "distasteful" and "cliche" for criticizing women of color for being successful in business.




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    The Nintendo Switch had a very good March

    Nintendo is selling a lot of Switches. The convertible console has been a lifesaver for people sheltering in place around the world. COVID-19-induced travel restrictions and the long-awaited arrival of Animal Crossing: New Horizons have proven to be a perfect storm for the three-year-old platform. New numbers out from NPD this morning shed some light […]




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    After 160,000 accounts are compromised, Nintendo shuts down NNID logins

    Nintendo today confirmed earlier reports of account breaches dating back over the past few weeks. The gaming giant issued an update (via Nintendo Japan) noting that around 160,000 Nintendo Accounts were impacted, which found multiple being used to purchase digital items without the owner’s consent. Along with the purchasing powers, the offending parties may have […]




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    Nintendo sells a lot more Switches, as people stay at home playing Animal Crossing

    A couple of weeks ago, we noted some new NPD numbers pointing to a very good March for the Switch. Nintendo’s financials this week bear out the predicted surge in popularity for the three-year-old console. The company has sold 21 million Switch units in the past year, handily beating a 19.5 million forecast; 6.2 million […]




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    First repatriation flight from London takes off for Mumbai