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Tenzing Assisted Delivery of Aspiration (TADA) technique for thrombectomy of medium vessel occlusions using the Freeclimb 54 catheter: multicenter experience
Get PDFBackground: Medium vessel occlusions (MeVOs) account for 25-40% of acute ischemic stroke. The Tenzing 5 (Route 92 Medical, San Mateo, California, USA) and FreeClimb 54 (Route 92 Medical, San Mateo, California, USA) catheter is a novel delivery-aspiration catheter combination designed to facilitate aspiration thrombectomy (AT) of MeVOs. We report our clinical experience using the Tenzing assisted delivery of aspiration (TADA) technique with FreeClimb 54 for first-line AT of MeVO.
Methods: We retrospectively reviewed consecutive patients who underwent MeVO first-line AT using TADA with FreeClimb 54 at nine institutions in the USA and one in New Zealand.
Results: 94 MeVOs (65 primary, 29 secondary) were treated in 92 patients: median age 71 (IQR 58-81) years; 49/92 (53%) women. FreeClimb 54 was successfully delivered by Tenzing 5 to all 94/94 MeVOs: 26 proximal M2; 44 distal M2; 5 M3; 6 A2; 4 A3; and 8 P2. Median target vessel diameter on DSA was 1.7 (IQR 1.4-1.8) mm. A leading microwire was used to advance Tenzing in 84% of cases. A stent retriever was used for additional thrombectomy passes in 6/94 (6%) patients. For a primary MeVO, final modified expanded Thrombolysis in Cerebral Infarction (meTICI) 2B-3 reperfusion was achieved in 63/65 (97%) patients, after a median of 1 (IQR 1-2) pass, with a first pass effect (FPE, meTICI 2C-3) in 43/65 (66%). Secondary MeVO FPE (eTICI 2C-3) was achieved in 20/29 (69%) patients. Tenzing 5-FreeClimb 54 related complications occurred in 2/94 (2%) patients: one perforation with asymptomatic subarachnoid hemorrhage and one embolus to new territory.
Conclusions: MeVO first-line AT using the TADA technique with Tenzing 5 and FreeClimb 54 had a high FPE with a low complication rate.No embarg
COVID-19 vaccine-associated reactive axillary lymph nodes on FDG PET/CT: a systematic review and meta-analysis
No full textPurpose: COVID-19 vaccine-induced reactive axillary lymph nodes (RAL) on fluorodeoxyglucose (FDG) PET/computed tomography (CT) imaging can mimic malignant lymphadenopathy, leading to diagnostic errors. Reported RAL prevalence varies widely in the literature, and factors contributing to its development remain poorly understood. This meta-analysis aims to evaluate vaccine-induced RAL observed on FDG PET/CT imaging and consolidate evidence from multiple studies to assess its prevalence, duration, and associations with vaccine-related factors and demographic characteristics.
Method: Using multiple databases, a systematic review and meta-analysis was conducted on studies reporting RAL on FDG PET/CT following COVID-19 vaccination. The primary outcome was RAL prevalence, while the secondary outcomes were maximum standardized uptake value (SUVmax), vaccine-to-scan interval, and associations with vaccine type and demographics.
Results: A total of 25 studies comprising of 5010 subjects were included. Mean SUVmax of reactive nodes was 2.8 ± 1.2. Overall, RAL prevalence was 38.6% ± 17.6, higher in females (58.1% versus 41.9%, P = 0.02) and younger individuals (mean age 63.3 versus 70.7 years, P = 0.03). The RAL rate was not statistically different between mRNA (39.9% ± 16.9) and non-mRNA vaccines (26.3% ± 30.9). However, subanalysis showed about 40% RAL with Pfizer and Moderna mRNA vaccines and AstraZeneca non-mRNA vaccine, versus much lower, below 20%, RAL with Sinovac and Johnson & Johnson non-mRNA vaccines. Stricter PET/CT interpretation criteria using blood pool threshold reduced RAL prevalence to <20%. RAL rate declined with time but was still present after 1 month.
Conclusion: Low activity RAL is common on FDG PET/CT after COVID-19 vaccination, while higher activity RAL (above blood pool) that can lead to clinical errors is less frequent. The frequency of RAL is affected by expected factors, such as age, gender, vaccine type, and time after vaccination, which indirectly suggest the link between RAL and COVID-19 postvaccinal immunity.No embarg
Employment Outcomes among People with Disabilities: Psychosocial Determinants
Get PDFA systematic scoping review of research published between 2000 and 2020 on employment of people with disabilities, that was funded by the National Institute on Disability, Independent Living, an Rehabilitation Research (NIDILRR), was conducted by CeKTER researchers. All papers comparing people with disabilities to those without were excluded from the systematic scoping review. Among over 100 publications reviewed there was a wide and very disparate array of findings with numerous variables used and varying research questions. This result belies summative findings. There are numerous ways of organizing the disparate findings. This brief is part of a series of findings from CeKTER’s systematic scoping review. In this brief we report on findings about a range of psychosocial determinants that impact the employment of people with disabilities, including determinants related to individual-level psychological characteristics, interpersonal skills and social support. Please note that all comparisons are always about corresponding peers with disabilities.The contents of this tip sheet were funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR), Grant #90DPEM0004. NIDILRR is a Center within the Administration for Community Living (ACL). ACL in the Department of Health and Human Services (HHS). The contents of this website do not necessarily represent the policy of NIDILRR, ACL, or HHS and you should not assume endorsement by the Federal Government.No embarg
Evaluating biomarkers in canine cytotoxic interface dermatitis reactions to account for clinical and histopathological similarities and differences
Get PDFCytotoxic interface dermatitis (CID) is a pattern reaction predominantly at the dermo-epidermal junction that encapsulates numerous chronic non-communicable inflammatory skin conditions in which the basal keratinocytes are attacked by T-cell infiltrate leading to apoptosis, lymphocytic satellitosis and vacuolar degeneration. Though many diseases include CID, the type of clinical presentation and tissue patterns expressed from disease to disease varies. In this study, we evaluate the commonalities and discrepancies in significantly expressed biomarkers across several CID conditions to examine their impact on clinical presentations in canines. Among the uniquely expressed genes in each disease, we observed significantly expressed in Discoid Lupus Erythematosus, in Epitheliotropic Lymphoma, and and in pemphigus affected dogs. With this knowledge, we may be able to use molecular signatures in combination with current treatment practices to develop a more targeted treatment plan for patients with CID.No embarg
Need for Engagement in Stroke Prevention Shared Decision-Making in Older Adults with Atrial Fibrillation and Multimorbidity
Get PDFAIM: To assess the prevalence of older adults with AF and multimorbidity expressing a need for greater involvement in SDM for stroke prevention and associated patient characteristics.
METHODS: A prospective cohort study (2016-2018) enrolled patients aged 65 years and older with AF from clinics in MA and Georgia. Participants with one or more chronic conditions were included in this study. To assess patient preferences for greater engagement in SDM, participants on oral anticoagulants were asked at the one-year follow-up if they would like to be more involved in deciding to take an anticoagulant and which oral anticoagulant to use for stroke prevention. Multivariable logistic regression analysis was used to identify patient characteristics associated with preference for more SDM engagement.
RESULTS: Among participants ( = 532; mean age: 75 years; 48% women, 87% White), 41% had 1-4 chronic conditions, 40% had 5-7, and 19% had 8 or more. Approximately one-third expressed a preference for both engaging in SDM on anticoagulation initiation and choosing the type of anticoagulant for stroke prevention. After multivariable adjustment, participants who were younger (aged 65-74 years), women, non-White, had less than high school education, higher perceived burden from anticoagulation use, or had fewer comorbidities, were more likely to report the need for greater SDM engagement for stroke prevention.
CONCLUSIONS: Clinicians should recognize the specific needs of older patients with AF and multimorbidity that seek greater involvement in SDM for stroke prevention. Providing tailored interventions can enhance stroke prevention decision-making in this vulnerable population.No embarg
Efficacy and Safety of Mechanical Thrombectomy in Distal Medium Middle Cerebral Artery Occlusion Ischemic Stroke Patients on Low-Dose Aspirin
No full textBackground: Acute ischemic stroke (AIS) from distal medium vessel occlusion (DMVO) presents unique treatment challenges. Mechanical thrombectomy (MT) is emerging as a viable option for these patients, yet the role of pre-stroke aspirin treatment is unclear. This study evaluates the impact of pre-stroke low-dose aspirin on outcomes in DMVO patients undergoing MT.
Methods: We conducted a multinational, multicenter, propensity score-weighted analysis within the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry. Patients with AIS due to DMVO, treated with MT, were included. We compared outcomes between patients on pre-stroke low-dose aspirin (75-100 mg) and those not on antiplatelet therapy. The primary outcome was functional independence at 90 days (mRS 0-2). Secondary outcomes included excellent functional outcome at 90 days (mRS 0-1), mortality, and day-one post-MT NIHSS score. Safety outcomes focused on hemorrhagic complications, including symptomatic intracerebral hemorrhage (sICH).
Results: Among 1,354 patients, 150 were on pre-stroke low-dose aspirin. After applying Inverse Probability of Treatment Weighting (IPTW), Aspirin use was associated with significantly better functional outcomes (mRS 0-2: OR =1.89 , 95% CI, 1.14 to 3.12 ) and lower 90-day mortality (OR = 0.56, 95% CI, 0.32 to 1.00). The aspirin group had lower NIHSS scores on day one (β = -1.5, 95% CI, -2.8 to - 0.27). The sICH rate was not significantly different between the groups (OR = 0.92, 95% CI, 0.60 to 1.43).
Conclusions: Pre-stroke low-dose aspirin was associated with improved functional outcomes and reduced mortality in patients with DMVO undergoing MT, without a significant increase in sICH. These findings suggest that low-dose aspirin may be safe and associated with more frequent excellent outcomes for this patient population. Further prospective studies are needed to validate these results and assess long-term outcomes.No embarg
"They don't know what it's really like:" qualitative insights into inpatient cardiac nurses' perceived workload
Get PDFBackground: Measurements of nursing workload often fail to reflect the complexity of nursing work. Nurses' perceived workload is shaped by many factors, including patient characteristics, personal, social, organizational, and environmental factors. There is a demonstrated interest in developing more comprehensive nurse workload measurement strategies, but little research has employed qualitative methods to investigate the beliefs and experiences of frontline staff. The purpose of this study was to explore inpatient nurses' perceptions of their workload and the factors that impact their percieved workload levels.
Methods: This was qualitative study using focus groups. Participants were recruited from the cardiac floors of an urban, academic medical center. A total of 17 nurses participated, including nurses from bedside, charge, educator, and nurse manager roles. Focus group transcripts were analyzed by a team of qualitative investigators using conventional content analysis.
Results: Inpatient nurses' perceived workload is shaped by their work volume, work attributes, and their ability to complete required tasks while providing meaningful, impactful care. The volume of nursing work is comprised of patient-focused, unit-focused, and institutional-focused tasks. Important work attributes include its perceived urgency, difficulty, alignment to the nurse and unit, interference, unpredictability, and individual nursing burden. Overall, participants expressed deep concern over high workloads that compromise holistic nursing care.
Conclusion: Strategies to more comprehensively measure nurses' perceived workload should account for the breadth and complexity of nursing work. Nurses should advocate for workload measurement systems that more closely reflect their subjective work experiences.
Clinical trial registration number: Not applicable.No embarg
Factors associated with improved outcomes after lumbar transforaminal epidural steroid injections for radicular pain: A systematic review
No full textPurpose: Despite numerous studies, the factors contributing to clinical success after a lumbar transforaminal epidural steroid injection (LTFESI) for radicular pain remain unclear. The aim of this study was to systematically review literature evaluating preprocedural predictive factors for improved outcomes in patients receiving a LTFESI.
Methods: We searched databases including PubMed/MEDLINE, Cochrane Library, and Scopus for studies published from 2006 through 2023. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to identify articles evaluating prognostic factors associated with outcomes after a LTFESI. Studies were excluded if articles treated patients with axial back pain or if they were not performed under imaging guidance with contrast medium. The quality of included studies was appraised by 2 reviewers using the Quality in Prognosis Studies tool (QUIPS).
Results: Eighteen studies met eligibility criteria which evaluated prognostic factors across domains including patient characteristics, clinical findings, magnetic resonance imaging (MRI) characteristics, anatomical variations, and electromyography findings. The largest predictive factor studied were the MRI findings causing radicular pain. A lower grade of nerve compression and a lumbar disc herniation which was central, foraminal or extraforaminal was associated with improved outcomes, as opposed to a subarticular location. Lower paraspinal mapping scores on electromyography were correlated with better outcomes than higher scores. Outcomes were not affected if a lumbar disc herniation was accompanied by degenerative changes or if the cause of radicular pain was from a lumbar disc herniation or from lumbar spinal stenosis. The risk of bias across many domains in the studies were varied being highest overall in the domains of study attrition and study confounding.
Conclusions: The evidence behind factors that predict outcomes from a lumbar transforaminal epidural steroid injection have varying degrees of bias, but trends appear that can be used to guide clinical decision making.No embarg
Implementing Advanced Comprehensive Diabetes Care Within the Veterans Affairs Learning Health System
Get PDFBackground: Telehealth can improve glycemic control for patients with type 2 diabetes (T2D), but programs must be designed in a manner that facilitates real-world uptake and effectiveness within learning health systems (LHS).
Objective: To highlight how the Veterans Affairs (VA) LHS supports real-world practice change by examining Advanced Comprehensive Diabetes Care (ACDC), a telehealth program for persistently poor T2D control, in the context of the Learning Health System Consolidated Framework (LHS-CF) taxonomy.
Design: Evaluation of program implementation within an LHS.
Participants: N = 1154 real-world ACDC participants INTERVENTIONS: ACDC is a 6-month program that leverages widely available VA telehealth infrastructure to deliver telemonitoring, self-management support, and medication management.
Main measures: In applying the LHS-CF, we accessed clinical hemoglobin A1c (HbA1c) data, examined ACDC encounter completion, and interviewed participants and staff.
Key results: ACDC's development benefited from LHS-CF Enabling Conditions, including a workforce prepared to engage in structured learning and quality improvement; well-developed clinical data systems; strong VA investments in innovation; and a collaborative culture. Consequently, ACDC has contributed to multiple LHS-CF-aligned Bodies of Work, including building new evidence to improve T2D outcomes; translation of effective, telehealth-based T2D care into practice; authentic engagement of partners; ongoing analyses of data to support effective care; and development of new approaches to foster innovation and improvement. In practice, ACDC has reduced HbA1c from 9.7% at baseline to 8.0% at 6 months (-1.7%, 95% CI -1.7, -1.6, p < 0.0001), with retention of this benefit at 4 years; the program has been delivered with good fidelity and has been valued by participants and staff.
Conclusions: The conditions created by VA's LHS facilitate the development, testing, and implementation of programs like ACDC, which promote further LHS success. As a result of its intentional development within VA's LHS, ACDC is well-positioned to improve outcomes for Veterans with poorly controlled T2D nationwide.No embarg
Aging in mice alters regionally enriched striatal astrocytes
Get PDFAging affects multiple organs and within the brain drives distinct molecular changes across different cell types. The striatum encodes motor behaviors that decline with age, but our understanding of how cells within the striatum change remains incomplete. Using single-cell RNA sequencing from young and aged mice we identify molecularly distinct astrocyte subtypes. We show that astrocytes change significantly with age, exhibiting downregulation of genes, reduced diversity, and a shift to more homogenous inflammatory transcriptomic profiles. By exploring where striatal astrocyte subtypes are located with single-cell resolution, we map astrocytes enriched in dorsal, medial, and ventral striatum. Age increases inflammatory marker transcripts in dorsal striatal astrocytes, which display greater age-related changes than ventral striatal astrocytes. We impute molecular interactions between astrocytes and neurons and find that age particularly reduced interactions related to Nrxn2. Our data show that aging alters regionally enriched striatal astrocytes asymmetrically, with dorsal striatal astrocytes exhibiting greater age-related molecular changes.No embarg