Yield of ASPECTS and Collateral CTA Selection for Mechanical Thrombectomy within 6–24 hours from Symptom Onset in a Hub and Spoke System

BackgroundRecent extended window trials support the benefit of mechanical thrombectomy in anterior circulation large vessel occlusions with clinical-radiographic dissociation. Using trial imaging criteria, 6% were found eligible for MT in the EW in a hub-and-spoke system. We examined the eligibility and outcomes in consecutive extended window-mechanical thrombectomy patients using more pragmatic selection criteria.MethodsWe retrospectively analyzed single-institution data of anterior circulation large vessel occlusions patients presenting between 6–24 h who underwent mechanical thrombectomy based on a priori determined criteria including non-contrast CT head ASPECTS ≥ 6 and/or CTA collateral scores ASITN/SIR 2-4. Primary outcomes consisted of post-mechanical thrombectomy TICI 2b-3 and 3-month modified Rankin scores; safety outcomes consisted of in-hospital mortality and symptomatic intracerebral hemorrhage.Results767 consecutive acute ischemic strokes patients presented within the 6-24 hour window, and of these 48 (6%) anterior circulation large vessel occlusions patients underwent mechanical thrombectomy. In this cohort the mean age was 63±17 years, 56% were male, the median NIHSS was 16 [IQR 10–19], the median ASPECTS was 9 (IQR 8-10), and 79% (n=38) had good CTA collaterals. Occlusions were primarily M1 MCA (46%), with 29% tandem occlusions. Successful recanalization (mTICI 2b or 3) was achieved in 73% (n=35), while 6% (n=3) of patients developed symptomatic intracerebral hemorrhage. In-hospital mortality was 25% (n=12) while 40% (n=19) achieved 3-month modified Rankin Scores 0–2.ConclusionsOur data suggest the use of pragmatic imaging approach of ASPECTS ≥6 with CTA collateral grade in extended time window which is already established in most hospitals.     

Vacuum myofascial therapy device for non-specific neck pain. A single blind randomized clinical trial

ObjectivesThis study aimed to investigate the efficacy of a vacuum myofascial therapy device (VT) for improving pressure pain thresholds (PPTs), range of motion (ROM), neck pain-related disability, pain, and quality of life in patients with non-specific neck pain.MethodsA randomized controlled trial in which thirty-eight participants with non-specific neck pain (NP) were randomly assigned to either an experimental (VT) or a comparison physical therapy program (PTP) group. The VT group (n = 19) received five sessions of treatment with a vacuum myofascial therapy device while the PTP group (n = 19) received five sessions of massage, ultrasound therapy (US), and transcutaneous electric nerve stimulation (TENS) over two weeks. The outcome measures were the numerical pain rating scale (NPRS), range of motion, quality of life (SF-12), neck disability Index (NDI), and PPTs at the end of treatment and at one-month follow-up.ResultsAlthough both groups experienced improvements in pain, neck disability, range of motion, and pressure pain, these only were statistically significant in the VT group. At one-month follow-up, the VT group still showed improvements in pain, neck disability, and range of motion.DiscussionVacuum myofascial therapy applied with a device offers similar results to other vacuum-based techniques such as cupping therapy. Moreover, in this device the parameters are digitally controlled, which allows for the precise reproduction of treatment.     

The Course of Eating Disorders Involving Bingeing and Purging Among Adolescent Girls: Prevalence,Stability, and Transitions

Purpose

To quantify eating disorder (ED) stability and diagnostic transition among a community-based sample of adolescents and young adult females in the United States.

Scholarly Collaboration,Mentorship, and Friendship: A New Model for Success in Academic Medicine

Mentorship can be one of the most important factors in helping faculty members successfully advance academic careers. Finding effective mentorship, however, is extremely challenging and lack of mentorship may negatively impact productivity, promotion, and retention. Women, in particular, identify lack of mentorship as a major factor inhibiting career advancement, which in turn may be one element contributing to the significant gender gaps existing in academic medicine. Here, we describe a model of mentoring drawn from our personal experiences as 4 female faculty that has resulted in a successful collaboration spanning nearly a decade. This model combines different elements of mentoring models previously described in the literature into a single model of network mentoring. Our model aims to promote longitudinal, collaborative scholarship around a broad common research theme, provide long-term mentorship focused on successfully navigating personal and academic hurdles, and create a forum of mentorship for faculty at all academic ranks. Keys to the success of our model, The Accelerate Scholarship through Personal Engagement with a Collaborative Team (ASPECT) Model, are: 1) a shared overarching research goal that allows for multiple projects to be worked on over time; 2) regular, structured meetings; 3) a collaborative yet flexible arrangement with “group accountability”; and 4) a focus on the human connection. Our goal in writing this paper is to describe, in detail, lessons learned from our experiences and reflect on why and how this model may be effective in addressing mentoring gaps many faculty members, particularly women, experience.     

血浆血栓素B2和6-酮-前列腺素F1α水平与新生儿窒息关系

为观察不同程度窒息新生儿血浆血栓素B2(TXB2)和6-酮-前列腺素F1α(6-Keto-PGF1α)含量变化及其规律,选择对照组20例,轻度窒息组19例,重度窒息组21例,均在生后6 h内取股静脉血2 ml,进行放射免疫分析.结果TXB2及其与6-Keto-PGF1α比值在对照组分别为(202.42±53.91)pg/ml、1.81±0.61,轻度窒息组分别为(646.29±121.66)pg/ml、3.73±1.27,重度窒息组分别为(1443.27±254.61)pg/ml、6.83±2.39,三组方差分析,组间差异有显著性(F值分别为286.19,49.78,P＜0.001);6-Keto-PGF1α升高,三组分别为(117.22±33.14)Pg/ml、(184.73±52.65)pg/ml、(223.45±63.48)pg/ml(P＜0.05).提示窒息新生儿血浆TXB2和6-Keto-PGF1α含量及两者之比明显升高,重度窒息组比轻度窒息组升高明显;与对照组相比,其升高程度与窒息程度有关.     

8—2岁市区学龄儿童感觉统合失调与不良行为及家庭因素调查分析

目的：调查本市区小学儿童感觉统合失调现状与不良行为及家庭因素的关系。方法：用感觉统合诊断量表和自制儿童生长发育调查表对1775名学龄儿童进行心理行为问题调查。结果：感觉统合轻度失调23．4％，重度失调13．5％，男童失调发和率（42．86％）明显高于女童（31．36％）P＜0．0），前庭功能失衡发生率最高（21．30％）；统合失调组儿童不良行为发生率高达64．38％明显高于统合正常组（31．11％）P＜0．01，失调组不良行为各因子的发生率亦明显高于统合正常组P＜0．01；学习能力不足儿童与父母文化程度和不同职业有关P＜0．01。结论：儿童感觉纺合失调现状易成为成人心理障碍的潜在因素，应引起重视。