Thrombolysis improves reperfusion and the clinical outcome in tandem occlusion stroke related to cervical dissection: TITAN and ETIS pooled analysis

BACKGROUND AND PURPOSE: Despite the widespread adoption of mechanical thrombectomy (MT) for the treatment of large vessel occlusion stroke (LVOS) in the anterior circulation, the optimal strategy for the treatment tandem occlusion related to cervical internal carotid artery (ICA) dissection is still debated. This individual patient pooled analysis investigated the safety and efficacy of prior intravenous thrombolysis (IVT) in anterior circulation tandem occlusion related to cervical ICA dissection treated with MT. METHODS: We performed a retrospective analysis of two merged prospective multicenter international real-world observational registries: Endovascular Treatment in Ischemic Stroke (ETIS) and Thrombectomy In TANdem occlusions (TITAN) registries. Data from MT performed in the treatment of tandem LVOS related to cervical ICA dissection between January 2012 and December 2019 at 24 comprehensive stroke centers were analyzed. The primary endpoint was a favorable outcome defined as 90-day modified Rankin Scale (mRS) score of 0-2. RESULTS: The study included 144 patients with tandem occlusion LVOS due to cervical ICA dissection, of whom 94 (65.3%) received IVT before MT. Prior IVT was significantly associated with a better clinical outcome considering the mRS shift analysis (common odds ratio, 2.59; 95% confidence interval [CI], 1.35 to 4.93; P=0.004 for a 1-point improvement) and excellent outcome (90-day mRS 0-1) (adjusted odds ratio [aOR], 4.23; 95% CI, 1.60 to 11.18). IVT was also associated with a higher rate of intracranial successful reperfusion (83.0% vs. 64.0%; aOR, 2.70; 95% CI, 1.21 to 6.03) and a lower rate of symptomatic intracranial hemorrhage (4.3% vs. 14.8%; aOR, 0.21; 95% CI, 0.05 to 0.80). CONCLUSIONS: Prior IVT before MT for the treatment of tandem occlusion related to cervical ICA dissection was safe and associated with an improved 90-day functional outcome

ACO based Clinical Decision Support System for Better Medical Care

In the realm of healthcare, the utilization of clinical decision support systems (CDSSs) has become increasingly prevalent as a means of providing medical professionals with a computer-based tool that grants them access to pertinent data and expertise, thereby aiding in their ability to make informed clinical decisions. The potential applications of a CDSS are numerous, ranging from disease diagnosis and the creation of treatment programs, to patient progress monitoring. A crucial component of a CDSS is its knowledge base, which comprises the data utilized by the system to generate recommendations and provide feedback to healthcare providers. In an effort to enhance the knowledge base of a CDSS for a particular clinical condition, metaheuristic methods such as Ant Colony Optimization (ACO) can be employed to select the most suitable and applicable data. ACO facilitates the identification of the portion of a CDSS's knowledge base that is most likely to result in the optimal clinical decision, from among the vast array of data that it may contain. This study aims to explore the potential benefits of utilizing ACO methods in CDSSs for the betterment of patient care. The paper outlines the design and implementation of an ACO-based CDSS, which can offer tailored treatment plans for patients based on their medical histories and current condition

Canning Preservation of Mango Slices

This study was carried out to investigate the effect of sugar syrup concentrations (15-30 oB), time (10-15 min) and temperature (80-100 oC) of thermal processing on various attributes i.e. acidity, ascorbic acid, overall acceptability and SPC. Canned mango slices contain 20 oB sugar syrup and thermally processed at 100 oC for 10 min results in good quality product. Processed mango slices can be stored at ambient storage condition (30±2 °C) for one year

Utilizing Computer Vision for the Analysis of Manufacturing Processes

hroughout the manufacturing industry, video recordings are used to help standardize work and develop training material for companies. Solme AB develops a software suite named AviX which aids in the analysis of these recordings. This report aims to evaluate how computer vision technology could be utilized to increase the functionality of the AviX suite. Furthermore, the report will evaluate how the technology could be used to automate analysis currently performed manually in the program. The evaluated features are face blur, tool highlighting, ergonomic risk detection, and footstep counting. A software platform is developed in Java, primarily with the use of OpenCV, to serve as a proof-of-concept for Solme. To support the flexibility of changing the set of enabled features, the application was constructed modularly and the features were implemented independently. The thesis concludes that there is potential to extend the functionality of the AviX suite by utilizing computer vision. Automated face blurring has been achieved with a considerable success rate, increasing the privacy of people appearing in the video recordings. Moreover, the automation of ergonomic risk detection showed promising results which indicate that manually performed analysis can indeed be automated

Increased blood pressure variability and the risk of probable dementia or mild cognitive impairment: A post hoc analysis of the SPRINT MIND trial

Background Increased systolic blood pressure variability (BPV) is associated with stroke, cardiovascular disease, and dementia and mild cognitive impairment. However, prior studies assessing the relationship between BPV and dementia or mild cognitive impairment had infrequent measurement of blood pressure or suboptimal blood pressure control. Methods and Results We performed a post hoc analysis of the SPRINT (Systolic Blood Pressure Intervention Trial) MIND (Memory and Cognition in Decreased Hypertension) trial. The primary outcome was probable dementia during follow-up. We defined our exposure period, during which blood pressures were collected, as the first 600 days of the trial, and outcomes were ascertained during the subsequent follow-up. BPV was measured as tertiles of systolic blood pressure standard deviation. We fit Cox proportional hazards models to our outcome. We included 8379 patients. The mean follow-up was 3.2±1.4 years, during which 316 (3.8%) patients developed dementia. The mean number of blood pressure measurements was 7.8, and in the tertiles of BPV, the SD was 6.3±1.6, 10.3±1.1, and 16.3±3.6 mm Hg, respectively. The rate of dementia was 2.4%, 3.6%, and 5.4% by ascending tertile, respectively

Characteristics and outcomes among US patients hospitalized for ischemic stroke before vs during the COVID-19 pandemic

Importance: After the emergence of COVID-19, studies reported a decrease in hospitalizations of patients with ischemic stroke (IS), but there are little to no data regarding hospitalizations for the remainder of 2020, including outcome data from a large cohort of patients with IS and comorbid COVID-19. Objective: To assess hospital discharge rates, demographic factors, and outcomes of hospitalization associated with the COVID-19 pandemic among US patients with IS before vs during the COVID-19 pandemic. Design, Setting, and Participants: This retrospective cohort study used data from the Vizient Clinical Data Base on 324 013 patients with IS at 478 nonfederal hospitals in 43 US states between January 1, 2019, and December 31, 2020. Patients were eligible if they were admitted to the hospital on a nonelective basis and were not receiving hospice care at the time of admission. A total of 41 166 discharged between January and March 2020 were excluded from the analysis because they had unreliable data on COVID-19 status, leaving 282 847 patients for the study. Exposure: Ischemic stroke and laboratory-confirmed COVID-19. Main Outcomes and Measures: Monthly counts of discharges among patients with IS in 2020. Demographic characteristics and outcomes, including in-hospital death, among patients with IS who were discharged in 2019 (control group) were compared with those of patients with IS with or without comorbid COVID-19 (COVID-19 and non-COVID-19 groups, respectively) who were discharged between April and December 2020. Results: Of the 282 847 patients included in the study, 165 912 (50.7% male; 63.4% White; 26.3% aged ≥80 years) were allocated to the control group; 111 418 of 116 935 patients (95.3%; 51.9% male; 62.8% White; 24.6% aged ≥80 years) were allocated to the non-COVID-19 group and 5517 of 116 935 patients (4.7%; 58.0% male; 42.5% White; 21.3% aged ≥80 years) to the COVID-19 group. A mean (SD) of 13 846 (553) discharges per month among patients with IS was reported in 2019. Discharges began decreasing in February 2020, reaching a low of 10 846 patients in April 2020 before returning to a prepandemic level of 13 639 patients by July 2020. A mean (SD) of 13 492 (554) discharges per month was recorded for the remainder of 2020. Black and Hispanic patients accounted for 21.4% and 7.0% of IS discharges in 2019, respectively, but accounted for 27.5% and 16.0% of those discharged with IS and comorbid COVID-19 in 2020. Compared with patients in the control and non-COVID-19 groups, those in the COVID-19 group were less likely to smoke (16.0% vs 17.2% vs 6.4%, respectively) and to have hypertension (73.0% vs 73.1% vs 68.2%) or dyslipidemia (61.2% vs 63.2% vs 56.6%) but were more likely to have diabetes (39.8% vs 40.5% vs 53.0%), obesity (16.2% vs 18.4% vs 24.5%), acute coronary syndrome (8.0% vs 9.2% vs 15.8%), or pulmonary embolus (1.9% vs 2.4% vs 6.8%) and to require intubation (11.3% vs 12.3% vs 37.6%). After adjusting for baseline factors, patients with IS and COVID-19 were more likely to die in the hospital than were patients with IS in 2019 (adjusted odds ratio, 5.17; 95% CI, 4.83-5.53; National Institutes of Health Stroke Scale adjusted odds ratio, 3.57; 95% CI, 3.15-4.05). Conclusions and Relevance: In this cohort study, after the emergence of COVID-19, hospital discharges of patients with IS decreased in the US but returned to prepandemic levels by July 2020. Among patients with IS between April and December 2020, comorbid COVID-19 was relatively common, particularly among Black and Hispanic populations, and morbidity was high

Treating MS after surviving PML: Discrete strategies for rescue, remission, and recovery patient 1: From the National Multiple Sclerosis Society Case Conference Proceedings

A 38-year-old woman with MS receiving natalizumab presented to the neurology clinic with the complaint of a new neurologic symptom

PREVALENCE OF ANXIETY SYMPTOMS AND ASSOCIATED FACTORS AMONG ADULTS IN NORTHWEST SYRIA

Introduction: In Northwest Syria, an area plagued by persistent conflict and instability, our understanding of the prevalence of anxiety remains limited. The aim of this study is to assess the occurrence of anxiety symptoms among adults living in Northwest Syria. Materials and Methods: This study was conducted with a cross-sectional approach, this research delves into the adult population residing in designated sub-districts of Northwest Syria, with a special emphasis on the Idlib district, covering both Idlib city and Atmeh camps. Targeting individuals aged 18 years and older, the study employed a straightforward random sampling method to recruit participants from these localities. Results: A total of 890 adults participated to the study. Nearly half of the participants (49%) identified as male, while over half (58%) were below 40 years old, and the majority (79%) were married. The findings revealed that 75% of participants exhibited symptoms of anxiety. Moreover, prolonged mobile phone usage, exceeding 4 hours daily, exhibited a correlation with heightened anxiety symptoms prevalence. Notably, geographical location acted as a modifier in the relationship between anxiety symptoms and mobile phone usage. Specifically, individuals in Idlib city demonstrated increased odds of anxiety symptoms with excessive phone usage. Conclusion: The study revealed a significant increase in anxiety symptoms, notably associated with excessive mobile phone usage, geographical location, gender, and income level. Women and those with lower incomes were notably vulnerable, with discernible variations observed across specific locations. Various factors, including those highlighted in the findings, alongside external influences such as the recent earthquake and persistent political unrest, collectively contribute to heightened susceptibility to anxiety among individuals in this region

Safety and efficacy of intra-arterial fibrinolytics as adjunct to mechanical thrombectomy : a systematic review and meta-analysis of observational data

Background Achieving the best possible reperfusion is a key determinant of clinical outcome after mechanical thrombectomy (MT). However, data on the safety and efficacy of intra-arterial (IA) fibrinolytics as an adjunct to MT with the intention to improve reperfusion are sparse. Methods We performed a PROSPERO-registered (CRD42020149124) systematic review and meta-analysis accessing MEDLINE, PubMed, and Embase from January 1, 2000 to January 1, 2020. A random-effect estimate (Mantel-Haenszel) was computed and summary OR with 95% CI were used as a measure of added IA fibrinolytics versus control on the risk of symptomatic intracranial hemorrhage (sICH) and secondary endpoints (modified Rankin ScalePeer reviewe

Impact of Emergent Cervical Carotid Stenting in Tandem Occlusion Strokes Treated by Thrombectomy: A Review of the TITAN Collaboration

Introduction: Endovascular therapy has been shown to be an effective and safe treatment for tandem occlusion. The endovascular therapeutic strategies for tandem occlusions strokes have not been adequately evaluated and the best approach is still controversial. The TITAN (Thrombectomy in TANdem occlusions) registry was a result of a collaborative effort to identify the best therapeutic approach for acute ischemic stroke due to tandem lesion. In this review, we aim to summarize the main findings of the TITAN study and discuss the challenges of treatment for tandem occlusion in the era of endovascular thrombectomy.Methods: A review of the data from the multicenter international observational and non-randomized TITAN registry was performed. The TITAN registry included acute ischemic stroke patients with tandem lesions (proximal intracranial occlusion and cervical carotid artery occlusion or stenosis>90%) who were treated with thrombectomy with or without carotid artery stenting.Results: Prior intravenous thrombolysis and emergent cervical carotid stenting were associated with higher reperfusion (mTICI 2b-3 and mTICI 3) rates at the end of the intervention. Poor outcome did not occur more frequently after stenting than after conservative treatment of the cervical carotid lesion. Emergent carotid stenting with antithrombotic agents and intracranial thrombectomy yielded higher reperfusion rate and good outcome (90 day mRS 0–2) compared to other strategies (carotid artery stenting and thrombectomy without antithrombotic, angioplasty and thrombectomy, or thrombectomy alone). Pretreatment intravenous thrombolysis was not associated with increased risk of hemorrhagic complications. Likewise, periprocedural unfractionated heparin did not modify the efficacy and safety results. Etiology of carotid artery lesion (atherosclerosis vs. dissection) did not emerge as predictor of outcome or recanalization.Conclusion: Emergent stenting of the cervical carotid lesion with antithrombotic agents in conjunction to thrombectomy appears to be the best treatment strategy for acute ischemic strokes with tandem lesions. These findings will be further investigated in the ongoing randomized controlled TITAN trial