Ischemic stroke is a leading cause of death and disability worldwide. Much of the long-term disability occurs in patients with Emergent Large Vessel Occlusion (ELVO). In fact, in these patients, occlusion of a major intracerebral artery results in a large area of brain injury often resulting in
Objective: This study aimed to assess the validity and utility of a machine learning (ML) model for predicting the 3-year incidence of neurodegenerative diseases (ND) in patients with type 2 diabetes (T2DM). Methods: We used data from two cohorts, the discovery cohort (one hospital; n=22,311) and the validation cohort (two hospitals; n=2,915) of patients with T2DM recruited between 2008-2022. The outcome of interest was the presence/absence of ND at 3 years. We selected different ML-based models with hyperparameter tuning in the discovery cohort and conducted an area under the receiver operating characteristic curve (AUROC) analysis in the validation cohort. Results: ND was observed in 133 (0.6%) in the discovery cohort and 15 (0.5%) in the validation cohort. The AdaBoost model had a mean AUROC of 0.82 (95% CI, 0.79-0.85) in the discovery dataset. When this result was applied to the validation dataset, the AdaBoost model exhibited the best performance among the models, with an AUROC of 0.83 (accuracy of 78.6%, sensitivity of 78.6%, specificity of 78.6%, and balanced accuracy of 78.6%). The most influential factors in the AdaBoost model were age and cardiovascular disease. Conclusion: This study demonstrates the potential utility of ML in predicting ND incidence in patients with T2DM, highlighting its feasibility for patient screening. Disclosure H. Sang: None. M. Lee: None. H. Lee: None. J. Park: None. S. Kim: None. H. Woo: None. Y. Hwang: None. T. Park: None. H. Lim: None. D. Yon: None. S. Rhee: None. Funding National Institutes of Health Research Project of South Korea (No. 2022-ER1102-01).
Obstructive sleep apnea (OSA), a common comorbidity in patients with stroke, has shown increasing prevalence over the past few decades. OSA is an important risk factor for stroke in addition to other well-known contributors, including hypertension, hyperlipidemia, atrial fibrillation, and diabetes mellitus. Moreover, OSA is an independent predictor of neurological outcomes and mortality. The pathological mechanisms underlying the association between OSA and stroke include autonomic dysfunction, hypertension, cardiac arrhythmia, dyslipidemia, impaired glucose tolerance, hypoxia, and inflammation. Continuous positive airway pressure (CPAP) therapy has proven clinical utility in improvement of neurological symptoms in patients with stroke. Findings from a CPAP withdrawal model have shown increased sympathetic activity in OSA with a consequent significant elevation in blood pressure, relevant cerebral hypoxia, and disturbed cardiac repolarization. In this review, we present an overview of the literature that describes an association between OSA and stroke in addition to the vascular risk factors, including hypertension, hyperlipidemia, atrial fibrillation, and diabetes mellitus. This study highlights the importance of early and accurate diagnosis and management of OSA for stroke prevention and care and will benefit physicians in clinical practice.
Despite the significance of the COVID-19 pandemic’s effect on life, only a few previous studies have been conducted on youth substance use during the era of the COVID-19 pandemic. Thus, we aimed to determine the change in alcohol and substance use by the familial-, social-, and individual-associated risk factors among Korean adolescents, comparing the pre- and during COVID-19 pandemic period. Data on 1,109,776 Korean adolescents aged 13 to 18 years from 2005 to 2021 were obtained in a nationwide, large-scale, and serial study. This study was conducted to compare the risk factors of alcohol and substance use for overall years and the transitional effect of the COVID-19 pandemic. Among one million adolescents during the pandemic (2019 versus 2021), lower school grades (ratio of odds ratio [ROR], 1.172; 95% CI, 1.075-1.279), male (ROR, 1.098; 95% CI, 1.008-1.197), lower educational levels of parents (ROR, 1.116; 95% CI, 1.002-1.215), and lower economic levels (ROR, 1.341; 95% CI, 1.026-1.754) were more pronounced and significant among alcohol users compared to the pre-pandemic period (2019 versus 2021). During the pandemic, higher school grades (ROR, 1.561; 95% CI, 1.166-2.090) and former smoking (ROR, 1.969; 95% CI, 1.290-3.003) were more pronounced and significant among substance users than in the pre-pandemic period. Over a million adolescents’ national data were used in this study to investigate changes in alcohol and drug use according to risk factors. Moreover, we compared how they were affected by the COVID-19 pandemic by comparing the change in risk factors in the pre-pandemic (2019) and pandemic periods (2021). The outcomes of this study suggest a complex interaction between a multitude of factors that influence adolescent alcohol and substance use.
Background and aims: Atrial fibrillation (AF) is a major cause of ischemic stroke; however, detailed clinical data and prognostic factors for stroke patients with AF are lacking in Korea. We aimed to investigate clinical information and factors associated with functional outcomes of stroke patients with AF from the Korean nationwide ATrial fibrillaTion EvaluatioN regisTry in Ischemic strOke patieNts (K-ATTENTION) database. Methods: From January 2013 to December 2015, consecutive clinical information from acute stroke patients with AF or history of AF was collected from 11 centers in Korea. Collected data included demographics, risk factors, pre-stroke medication, stroke severity, stroke subtypes, concomitant cerebral atherosclerosis, brain image findings, recanalization therapy, discharge medication, and functional outcome at 3 months after index stroke. Results: A total of 3,213 stroke patients (mean age, 73.6 ± 9.8 years; female, 48.6%) were included. The mean CHA2DS2-VASc score was 4.9. Among the 1,849 (57.5%) patients who had brain image and functional outcome data, poor outcome (modified Rankin scale > 2) was noted in 53.1% (981/1,849) of patients. After adjusting for age, sex, and variables that had a p < 0.05 in univariate analysis or well-known factors for functional outcome, presence of asymptomatic extracranial cerebral atherosclerosis [odd ratio (OR): 1.96, 95% confidence interval (CI): 1.36-2.82, p = 0.001] and less frequent prior stroke statin intake (OR: 0.69, 95% CI: 0.49-0.98, p = 0.038) were associated with poor functional outcome. Conclusion: Our results suggest that presence of non-relevant extracranial cerebral atherosclerosis may affect poor functional outcome and prior stroke statin therapy may be feasible in Korean stroke patients with AF.
Oral diseases or poor oral hygiene have close connections with systemic inflammatory reaction, which is one of major mechanism in the development of chronic kidney disease (CKD). We conducted a research assuming that better oral hygiene care would be negatively related with the risk of developing new-onset CKD.
From 2003 to 2004, a total of 158,495 participants from the Korean national health insurance data sharing service which provides health screening data including variables as age, sex, vascular risk factors, medication information, indicators regarding oral hygiene, and laboratory results. The diagnosis of CKD and vascular risk factors were defined according to the International Statistical Classification of Diseases and Related Health Problems codes-10th revision. The follow-up period for the study subject was until the occurrence of CKD, until death, or Dec 31, 2015.
Approximately 13.3% of the participants suffered from periodontal disease, and 40.7% brushed their teeth at least three times a day. With a median of 11.6 (interquartile range 11.3–12.2) years’ follow-up, the cohort included 3223 cases of incident CKD. The 10-year incidence rate for CKD was 1.80%. In multivariable analysis with adjustment for age, sex, demographics, vascular risk factors, blood pressure, and blood laboratory results, frequent tooth brushing (≥3 times a day) was negatively related to occurrence of CKD (hazard ratio: 0.90, 95% confidence interval [0.83–0.99], P = .043, P value for trend = .043).Participants with improved oral hygiene (≥3 times a day) have showed less risk of CKD. Additional interventional studies are in need to establish causative relationship between oral hygiene and risk of CKD.
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