The coronavirus disease 2019 (COVID-19) pandemic can have a profound impact on the mental health of patients who survived the illness. However, little is known about the prevalence rate of mental health disorders among hospital discharged COVID-19 patients and its associated factors. A cross-sectional survey of hospital discharged patients was conducted April 11-22, 2020 in Wuhan, China (where the pandemic began). 675 participants completed the survey, including 90 (13.3%) medical staff (physicians and nurses who had been ill). We used Fisher's exact test and multivariable logistic regression methods to explore the risk factors associated with mental health problems (anxiety, depression, and PTSD symptoms associated with COVID-19 hospitalization). Adverse mental health effects of COVID-19 are evident after discharge from the hospital, with sleep difficulties highlighted as a central issue. As we found that perceived discrimination was a central predictor of mental illness, preventing and addressing social stigma associated with COVID-19 may be crucial for improving mental health for recovered patients.
• Radiomics analysis of pre-CRT multiparameter MR images could predict pCR in patients with LARC. • Proposed radiomics signature from joint T2-w, ADC and cT1-w images showed better predictive performance than individual signatures. • Most of the clinical characteristics were unable to predict pCR.
Background and Purpose
High revascularization rates in large-vessel occlusion strokes treated by mechanical thrombectomy are not always associated with good clinical outcomes. We evaluated predictors of functional dependence despite successful revascularization among patients with acute ischemic stroke treated with thrombectomy.
Methods
We analyzed the pooled data from the Multi Mechanical Embolus Removal in Cerebral Ischemia (MERCI), Thrombectomy Revascularization of Large Vessel Occlusions in Acute Ischemic Stroke (TREVO), and TREVO 2 trials. Successful revascularization was defined as thrombolysis in cerebral infarction score 2b or 3. Functional dependence was defined as a score of 3 to 6 on the modified Rankin Scale at 3 months. We assessed relationship of demographic, clinical, angiographic characteristics, and hemorrhage with functional dependence despite successful revascularization.
Results
Two hundred and twenty-eight patients with successful revascularization had clinical outcome follow-up. The rates of functional dependence with endovascular success were 48.6% for Trevo thrombectomy and 58.0% for Merci thrombectomy. Age (odds ratio, 1.04; 95% confidence interval, 1.02–1.06 per 1-year increase), National Institutes of Health Stroke Scale score (odds ratio, 1.08; 95% confidence interval, 1.02–1.15 per 1-point increase), and symptom onset to endovascular treatment time (odds ratio, 1.11; 95% confidence interval, 1.01–1.22 per 30-minute delay) were predictors of functional dependence despite successful revascularization. Symptom onset to reperfusion time beyond 5 hours was associated with functional dependence. All subjects with symptomatic intracranial hemorrhage had functional dependence.
Conclusions
One half of patients with successful mechanical thrombectomy do not have good outcomes. Age, severe neurological deficits, and delayed endovascular treatment were associated with functional dependence despite successful revascularization. Our data support efforts to minimize delays to endovascular therapy in patients with acute ischemic stroke to improve outcomes.
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