Suchergebnisse

Joanna Narbutt,1 Janusz KrzyÅ›cin,2 Piotr Sobolewski,2 MaÅ'gorzata SkibiÅ"ska,1 Marcin Noweta,1 Witold Owczarek,3 Bonawentura Rajewska-WiÄ™ch,2 Aleksandra Lesiak1 1Department of Dermatology, Pediatric Dermatology and Oncology, Medical University of Åódź, Åódź, Poland; 2Institute of Geophysics, Polish Academy of Sciences, Warsaw, Poland; 3Department of Dermatology, Military Institute of Medicine, Warsaw, PolandCorrespondence: Janusz KrzyÅ›cinInstitute of Geophysics, Polish Academy of Sciences, Warsaw, 01-452, PolandTel +48-2269-15950Email jkrzys@igf.edu.plBackground: Nowadays, patients with moderate-to-severe psoriasis are treated with conventional immunosuppressants or with new biological agents. Phototherapy is the first-line treatment for patients in whom topical therapy is insufficient. Although numerous studies have been carried out, it is still difficult to predict the outcome of phototherapy in individual patients.Methods: Prior to standard narrow band (NB) ultraviolet B (UVB) phototherapy, the patients filled out a questionnaire about personal life and health status. Several standard blood tests, including selected cytokine levels, were performed before and after a course of 20 NB-UVB treatments. The questionnaire answers, results of the blood tests, and treatment outcomes were analyzed using an artificial intelligence approach—the random forest (RF) classification tool.Results: A total of 82 participants with moderate-to-severe psoriasis were enrolled. Prior to starting phototherapy, the patients with expected good outcome from the phototherapy, shorter remission, and quitting a possible second course of the NB-UVB treatment could be identified by the RF classifier with sensitivity over 84%, and accuracy of 75%, 85%, and 79%, respectively. The inclusion of cytokine data did not improve the performance of the RF classifier.Conclusion: This approach offers help in making clinical decisions by identifying psoriatic patients in whom phototherapy will significantly improve their skin, or those in whom other therapies should be recommended beforehand.Keywords: psoriasis, phototherapy, outcome prediction, artificial intelligence

[Background and objective] The optimal timing for initiation of dabigatran after acute ischaemic stroke (AIS) is not established. We aimed to evaluate initiation timing and clinical outcomes of dabigatran in AIS patients with non-valvular atrial fibrillation (NVAF). ; [Design] Retrospective study based on prospectively collected data in SITS (Safe Implementation of Treatment in Stroke) Thrombolysis and Thrombectomy Registry from July 2014 to July 2018. ; [Participants] European NVAF patients (≥18 years) hospitalised after first-ever ischaemic stroke. ; [Setting] A multinational, observational monitoring register. ; [Intervention] Dabigatran initiation within 3 months after the ischaemic stroke. ; [Primary and secondary outcomes] The primary outcome was time from first-ever ischaemic stroke (index event) to dabigatran initiation. Additional outcomes included physicians' reasons for delaying dabigatran initiation beyond acute hospital discharge and outcomes within 3 months of index event. ; [Methods] We identified patients with NVAF who received dabigatran within 3 months of the index event. We performed descriptive statistics for baseline and demographic data and clinical outcomes after dabigatran initiation. ; [Results] In total, 1489 patients with NVAF received dabigatran after AIS treated with thrombolysis and/or thrombectomy. Of these, 1240 had available initiation time. At baseline, median age was 75 years; 53% of patients were women, 15% were receiving an oral anticoagulant, 29% acetylsalicylic acid and 4% clopidogrel. Most patients (82%) initiated dabigatran within 14 days after the index event. Patients initiating earlier had lower stroke severity from median NIHSS 8 (IQR 6–13) if initiated within 7 days to NIHSS 15 (9–19) if initiated between 28 days and 3 months. Most common reasons for delaying initiation were haemorrhagic transformation or intracranial haemorrhage, stroke severity and infarct size. Few thrombotic/haemorrhagic events occurred within 3 months after the index event (20 of 926 patients, 2.2% with the available data). ; [Conclusions] Our findings, together with previous observational studies, indicate that dabigatran initiated within the first days after an AIS is safe in patients treated with intravenous thrombolysis, endovascular thrombectomy or both. ; [Trial registration number] SITS Thrombolysis and Thrombectomy Registry (NCT03258645). ; This study is sponsored by Boehringer-Ingelheim. In addition, the SITS registry is financed directly and indirectly by grants from Karolinska Institutet, Stockholm County Council, the Swedish Heart-Lung Foundation, the Swedish Order of St. John, Friends of Karolinska Institutet, private donors as well as from an unrestricted sponsorship from Boehringer-Ingelheim. SITS has previously received grants from the European Union Framework 7, the European Union Public Health Authority and Ferrer International, EVER Pharma. SITS is currently conducting studies supported by Boehringer-Ingelheim as well as in collaboration with Karolinska Institutet supported by Stryker, Covidien and Phenox. IE-M has received a grant from 'Fundación Progreso y Salud, Junta de Andalucía' (grant EF-0437-2018).