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Sundar Kaushik,Paulraj Sabharisundarvel,Choudhury Shuvro Roy,Hassan Haseeb,Sengupta Judhajit,Pattari Sanjib Kumar 대한신경중재치료의학회 2021 Neurointervention Vol.16 No.1
Cerebral venous thrombosis (CVT) is a rare clinical entity, with clinical presentations extending from headache and seizures to coma and death. For adults developing progressive neurological worsening despite adequate medical management, endovascular thrombolysis and/or mechanical thrombectomy may be considered as treatment options. We present one such patient with CVT who developed seizures and slipped into a coma, despite best medical management. A large-bore aspiration catheter was used as a standalone system for the endovascular procedure. The venous sinuses were successfully re-canalized. The patient was discharged a week later with a modified Rankin scale of 2. Studies show that endovascular thrombolysis used alone or in conjunction with thrombectomy for CVT has a higher risk of hemorrhagic complications. If we were to use mechanical thrombectomy devices (that are specifically designed for intracranial clot retrieval) as a stand-alone system, we would probably have better clinical outcomes with a lower risk of hemorrhagic complications.
Sundar, R,Huang, K K,Qamra, A,Kim, K -M,Kim, S T,Kang, W K,Tan, A L K,Lee, J,Tan, P Oxford University Press 2019 Annals of oncology Vol.30 No.3
<P><B>Abstract</B></P><P><B>Background</B></P><P>Utilization of alternative transcription start sites through alterations in epigenetic promoter regions causes reduced expression of immunogenic N-terminal peptides, which may facilitate immune evasion in early gastric cancer. We hypothesized that tumors with high alternate promoter utilization would be resistant to immune checkpoint inhibition in metastatic gastric cancer.</P><P><B>Patients and methods</B></P><P>Two cohorts of patients with metastatic gastric cancer treated with immunotherapy were analyzed. The first cohort (<I>N </I>=<I> </I>24) included patients treated with either nivolumab or pembrolizumab. Alternate promoter utilization was measured using the NanoString<SUP>®</SUP> (NanoString Technologies, Seattle, WA, USA) platform on archival tissue samples. The second cohort was a phase II clinical trial of patients uniformly treated with pembrolizumab (<I>N </I>=<I> </I>37). Fresh tumor biopsies were obtained, and transcriptomic analysis was carried out on RNAseq data. Alternate promoter utilization was correlated to T-cell cytolytic activity, objective response rate and survival.</P><P><B>Results</B></P><P>In the first cohort 8 of 24 (33%) tumors were identified to have high alternate promoter utilization (AP<SUB>high</SUB>), and this was used to define the AP<SUB>high</SUB> tertile of the second cohort (13 AP<SUB>high</SUB> of 37). AP<SUB>high</SUB> tumors exhibited decreased markers of T-cell cytolytic activity and lower response rates (8% versus 42%, <I>P </I>=<I> </I>0.03). Median progression-free survival was lower in the AP<SUB>high</SUB> group (55 versus 180 days, <I>P </I>=<I> </I>0.0076). In multivariate analysis, alternative promoter utilization was an independent predictor of immunotherapy survival [hazard ratio 0.29, 95% confidence interval 0.099–0.85, <I>P </I>=<I> </I>0.024). Analyzing tumoral evolution through paired pre-treatment and post-treatment biopsies, we observed consistent shifts in alternative promoter utilization rate associated with clinical response.</P><P><B>Conclusion</B></P><P>A substantial proportion of metastatic gastric cancers utilize alternate promoters as a mechanism of immune evasion, and these tumors may be resistant to anti-PD1 immune checkpoint inhibition. Alternate promoter utilization is thus a potential mechanism of resistance to immune checkpoint inhibition, and a novel predictive biomarker for immunotherapy.</P><P><B>Trial Registration</B></P><P>ClinicalTrials.gov Identifier: NCT#02589496</P>
Sundar, S. Shyam,Bellur, Saraswathi,Oh, Jeeyun,Jia, Haiyan,Kim, Hyang-Sook SAGE Publications 2016 COMMUNICATION RESEARCH - Vol.43 No.5
<P>A critical determinant of message interactivity is the presence of contingency, that is, the messages we receive are contingent upon the messages we send, leading to a threaded loop of interdependent messages. While this “conversational ideal” is easily achieved in face-to-face and computer-mediated communications (CMC), imbuing contingency in human-computer interaction (HCI) is a challenge. We propose two interface features—interaction history and synchronous chat—for increasing perceptions of contingency, and therefore user engagement. We test it with a five-condition, between-participants experiment (<I>N</I> = 110) on a movie search site. Data suggest that interaction history can indeed heighten perceptions of contingency and dialogue, but is perceived as less interactive than chatting. However, the chat function does not appreciably increase perceived contingency or user engagement, both of which are shown to mediate the effects of message interactivity on attitudes toward the site. Theoretical implications for interactivity research and practical implications for interaction design are discussed.</P>