2,903 research outputs found
Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke: Primary Results of the STRATIS Registry
No full textFull author list omitted for brevity. For the full list of authors, see article.BACKGROUND AND PURPOSE: Mechanical thrombectomy with stent retrievers has become standard of care for treatment of acute ischemic stroke patients because of large vessel occlusion. The STRATIS registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) aimed to assess whether similar process timelines, technical, and functional outcomes could be achieved in a large real world cohort as in the randomized trials. METHODS: STRATIS was designed to prospectively enroll patients treated in the United States with a Solitaire Revascularization Device and Mindframe Capture Low Profile Revascularization Device within 8 hours from symptom onset. The STRATIS cohort was compared with the interventional cohort of a previously published SEER patient-level meta-analysis. RESULTS: A total of 984 patients treated at 55 sites were analyzed. The mean National Institutes of Health Stroke Scale score was 17.3. Intravenous tissue-type plasminogen activator was administered in 64.0%. The median time from onset to arrival in the enrolling hospital, door to puncture, and puncture to reperfusion were 138, 72, and 36 minutes, respectively. The Core lab-adjudicated modified Thrombolysis in Cerebral Infarction > /=2b was achieved in 87.9% of patients. At 90 days, 56.5% achieved a modified Rankin Scale score of 0 to 2, all-cause mortality was 14.4%, and 1.4% suffered a symptomatic intracranial hemorrhage. The median time from emergency medical services scene arrival to puncture was 152 minutes, and each hour delay in this interval was associated with a 5.5% absolute decline in the likelihood of achieving modified Rankin Scale score 0 to 2. CONCLUSIONS: This largest-to-date Solitaire registry documents that the results of the randomized trials can be reproduced in the community. The decrease of clinical benefit over time warrants optimization of the system of care. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02239640
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Abstract TP19: Thrombectomy in Medium Arteries Works for Distal Vessel Occlusions in Acute Ischemic Stroke - STRATIS
No full textBackground:
Mechanical thrombectomy is established for large vessel occlusions in acute ischemic stroke, but the potential role in distal vessel occlusions of medium arteries is largely unknown. Such distal arterial segments have not been measured with respect to thrombectomy devices used during endovascular therapy. We conducted a systematic analysis of arterial size, segmental anatomy and stent retriever device performance during thrombectomy.
Methods:
The STRATIS angiography core lab adjudicated the exact location of the occlusion, proximal and distal device deployment, relationship to arterial bifurcations and anatomical nomenclature. Arterial diameters were measured at all of these sites. Statistical analyses examined the relationship between these variables, arterial recanalization and eTICI reperfusion.
Results:
Thrombectomy was performed with various device sizes, including Solitaire 4x40 in 36.3% (306/844), Solitaire 6x30 in 31.4% (265/844), Solitaire 4x20 in 26.4% (223/844), unspecified in 3.8% (32/844), Solitaire 6x20 in 1.3% (11/844) and Solitaire 4x15 in 0.8% (7/844). Arterial diameter at the occlusion site was median 2.17mm (1.40-3.59) in the distal M1, 1.67mm (0.81-2.98) in the proximal M2, 1.50mm (0.92-1.99) in the distal M2, 1.24mm (0.67-2.00) in the M3 and 1.88mm (1.49-1.94) in the P1. Considerable overlap was noted between arterial sizes at occlusion sites carrying different segmental arterial nomenclature or vessel names. During device deployment in STRATIS, median arterial diameter at the occlusion site was 2.4mm (IQR 1.9, 3.4), 2.9mm (IQR 2.2, 3.6) at the proximal stent marker and 1.4mm (IQR 1.2, 1.7) at the distal stent marker. Substantial eTICI reperfusion (2b-3) was achieved in all distal vessel occlusions (Table 1).
Conclusions:
Substantial reperfusion may be achieved with currently available mechanical thrombectomy devices for distal vessel occlusions in medium arteries
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Abstract TP36: Collaterals Negate Time: Topography and Determinants of Baseline ASPECTS in STRATIS
No full textBackground:
ASPECTS is routinely used to estimate ischemic lesion burden in acute stroke, yet the topography and influence of collaterals has been unexplored. Imaging selection for endovascular therapy in various time epochs may also be simplified with ASPECTS. We leveraged the large-scale registry data of STRATIS to discern the role of collaterals, time and other factors in ASPECTS topography at baseline.
Methods:
The STRATIS Imaging Core Lab, blind to all clinical data, independently determined ASPECTS scores and regional involvement in anterior circulation occlusions. Collateral status on baseline angiography was scored by ASITN grade. Statistical analyses described ASPECTS regional involvement or topography based on arterial occlusion site and other variables available prior to intervention, determining the influence of collaterals and time duration from onset to imaging.
Results:
Baseline ASPECTS (n=573) was median 8.0 (2, 10). ASPECTS regions involved were lenticular nuclei 62.3% (357/573), insula 42.2% (242/573), caudate 23.4% (134/573), M2 13.6% (78/573), M4 9.4% (54/573), M5 9.2% (53/573), M1 4.0% (23/573), M3 2.1% (12/573), M6 1.9% (11/573) and internal capsule 0.2% (1/573). Distinct patterns or topography differentiated ICA, M1 and M2 arterial occlusion sites at angiography. Overall, higher ASPECTS (7-10 vs. ≤ 6) was linked with more robust collaterals (p<0.001) and shorter duration from onset to CT (p=0.001), yet collateral grade was unrelated to time. Ordinal multivariate logistic regression on ASPECTS containing collateral grade and time (from onset to CT) as covariates demonstrated that they were significantly associated (p<0.001 and p=0.0024, respectively) with ASPECTS.
Conclusions:
ASPECTS topography and the extent of ischemic changes are a product of arterial occlusion site, collateral status and time duration. ASPECTS may infer collateral status, a pivotal determinant of outcome in endovascular therapy, irrespective of time from symptom onset
Discourse on formation of investigators’ competencies
No full textOne of the most important aims of law enforcement agencies is crime investigation and
prevention. Consequently, one of the main activities of the law enforcement agencies, especially in the
pre-trial investigation sphere, is to optimise the organisation of the pre-trial investigation in order to
save the experienced skilled and competent specialists. The author of this research offers a new
approach and analyses the qualification and competence of the pre-trial investigation subjects not only
in terms of personnel management, but all elements of the model of pre-trial investigation to make
pre-trial investigation organisation more effective. It should be noted that the content of an
investigators‘ qualification or levels of competence are still not determined or strictly regulated and
this is the reason for many discussions in this area. These discussions surround what qualification and level of competence the investigators should have in pre-trial investigation, what general and special
competencies they should acquire and how the content of the competencies should be determined. In the present article the author analyses the investigators‘ qualification and competence as a
presumption that it is an essential aspect of an effective pre-trial investigation. Analysing this question
the author compares other subjects such as the regulation of qualifications and levels of competence of
the prosecutors and pre-trial investigation judges. The author also identifies the problem of how to
define an investigators qualification and level of competence making recommendations to create a
Description of Investigators Competencies. Qualification requirements should be determined in this
legal act and general, occupational and special competencies should be identified with the content also
being determined within this framework. Formation of the Description of Investigators‘ Competencies
should determine not only the content of the investigators‘ required level of competence but also this
process should be consistent with the assessment and career development of investigators‘ including
the process of gaining the investigators‘ qualification. The aim of this research is to identify the problems associated with defining an investigators‘
qualification and levels of competence and to propose recommendations on how this could be
achieved. The subject of this research is limited to only looking at investigators‘ qualification and
level of competence. The author is using a qualitative method for this research based upon the contents of documents.
The author will analysis eight legal acts related to the qualification and competence of pre-trial
investigation and fifty different investigators‘ job descriptions.Straipsnyje nagrinėjama ikiteisminio tyrimo pareigūnų (tyrėjų) kvalifikacija ir kompetencija kaip viena iš veiksmingo ikiteisminio tyrimo organizavimo prielaidų. Analizuojant tyrėjų kvalifikacijos ir kompetencijos turinį ir jo reglamentavimą, lyginama kitų ikiteisminio tyrimo subjektų – prokurorų ir ikiteisminio tyrimo teisėjų – kvalifikacijos ir kompetencijos turinio reglamentavimo ypatumai, identifikuojamos tyrėjų kvalifikacijos ir kompetencijos apibrėžties problemos ir pateikiami sprendimo būdai – siūlomas ikiteisminio tyrimo pareigūnų (tyrėjų) kompetencijų aprašas, kuriame būtų tiksliai nustatyti tyrėjų kvalifikaciniai reikalavimai, identifikuotos bendrosios, profesinės ir specialiosios kompetencijos ir apibrėžtas šių kompetencijų turinys. Ikiteisminio tyrimo pareigūnų kompetencijų aprašo suformavimas sudarytų galimybę ne tik aiškiai apibrėžti tyrėjo kompetencijos turinį, bet ir šį procesą nuosekliai susieti su tyrėjo veiklos vertinimu, karjera ir kvalifikacijos tobulinimu. Straipsnį sudaro įvadas ir dvi dalys. Pirmoje dalyje nagrinėjama tyrėjo kvalifikacijos apibrėžties problematika, gretinama ikiteisminio tyrimo pareigūno, prokuroro ir teisėjo kvalifikacijos apibrėžtys. Šioje dalyje siūloma tiksliai nustatyti ir apibrėžti tyrėjo kvalifikacinius reikalavimus. Antrojoje dalyje analizuojama tyrėjo kompetencijos turinys. Nagrinėjant prokurorų, teisėjų kompetencijos turinį ir jo reglamentavimo ypatumus, siūloma sudaryti tyrėjo kompetencijų aprašą, kuriame būtų tiksliai apibrėžtas tyrėjo kompetencijos turinys
Sepsis-driven temporal variability in cytokine secretion and heart rate is potentiated by withdrawing vagal innervation: Evidence of higher order neuroimmunological communication via the cholinergic anti-inflammatory pathway in the ovine fetus near term
No full textFetal brain-gut communication is disrupted during sepsis and associated with a higher degree of intestinal inflammation: Implications for non-evasive monitoring
No full textInternet technologies relevant to private investigators’ working practices
No full textMuch has been written and discussed especially in the various US media and in legislative organs, about how the Internet is used illegally (hacking, stalking for instance), but hardly if any research has been done as to how the investigative industry employs the new medium to its benefit. The author described in this thesis how private investigators (PIs) execute their profession these days using the facilities the Internet avail them in contrast to the time before the dawn of the Internet. This contrast is also investigated in an international context, an important part of the thesis, drawn from the author's 32 years of international business experience and that of PIs worldwide. The availability of the various online facilities in different countries are compared. To better understand the new medium, and its facilities a short outline of the Internet’s history, it’s set up in general and for the use of PIs in particular is supplied. PIs also face limitations in their daily work, limitations originating from online, legal, educational, financial and international causes. The new medium not only helps PIs in their investigative, but also in their office work. Finally PIs' wishes for new tools to facilitate their daily investigative work and their outlook as to where the new medium will head are also discussed
A signature of fetal systemic inflammatory response in the temporal pattern of heart rate variability measures
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Abstract TMP4: Serial ASPECTS from Baseline to 24 Hours: Impact of Endovascular Therapy in STRATIS
No full textBackground:
Serial ASPECTS of ischemic stroke lesion evolution from baseline to 24-hours has been established as an effective surrogate endpoint in endovascular therapy. The use of this imaging shift has not been implemented beyond thrombectomy trials to estimate impact of endovascular therapy in large-scale registry data.
Methods:
The STRATIS Imaging Core Lab, blind to all clinical data, independently determined ASPECTS scores on baseline and 24-hour studies. ASPECTS regional involvement and resulting total scores were analyzed in anterior circulation occlusions in STRATIS. Statistical analyses calculated the proportion of subjects with 0 ASPECTS score shift and separately, those with shifts >4, 5, 6 points. Clinical predictors of ASPECTS shift and regional involvement were determined.
Results:
Baseline ASPECTS (n=517) was 8.2 ± 1.59 (median 8.0 (2, 10)) and 24-hour ASPECTS (n=547) was 6.0 ± 2.92 (median 7.0 (0, 10)). Serial ASPECTS (n=487) revealed change of -2.1 ± 2.41 (median-1.0 (-10, 3)). Absolutely no change in ASPECTS, or 0 shift from baseline to 24 hours, occurred in 157/487 (32%). Substantial ASPECTS decline of ≥4 occurred in 117/487 (24%), with ≥5 in 76/487 (16%) and ≥6 in 51/487 (10%). ASPECTS decline was linked with baseline collaterals (ASITN 4 (n=19; -0.9 ± 1.05); 3 (n=117; -0.8 ± 1.21); 2 (n=140; -2.6 ± 2.27); 1 (n=29; -3.6 ± 2.34); 0 (n=10; -4.2 ± 3.08)) and the degree of subsequent reperfusion (oTICI 3 (n=63; -1.1 ± 1.94); 2B (n=282; -1.9 ± 2.32); 2A (n=103; -3.4 ± 2.38); 1 (n=2; -3.0 ± 1.41); 0 (n=10; -4.0 ± 2.75)). Baseline predictors of ≥6 ASPECTS decline included previous TIA (OR 3.10 (95%CI 1.32, 7.31), diabetes (OR 2.23 (95%CI 1.22, 4.07)) and baseline NIHSS (OR 1.10 (95%CI 1.03, 1.16).
Conclusions:
Frozen ASPECTS or 0 shift from baseline to 24 hours occurs in about 1/3 of all cases treated with endovascular therapy in a large-scale registry. Poor collaterals, prior TIA, diabetes and elevated baseline NIHSS may be important predictors of those likely to experience infarct evolution despite reperfusion, identifying optimal candidates for neuroprotection with endovascular therapy
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