ASPECT Score Research Articles

A study on measuring an objective aspect score for analysis in forestry

In forestry, measurements are made to understand the state of natural ecosystems and their changes. The studies have reported that geographical features such as elevation, slope and aspect affect the ecosystem dramatically and that it is crucial to measure them accurately. Also, in forestry analysis and risk assessments, these features are required to be scored objectively and accurately. Elevation and slope can be easily measured and scored using GISbased systems. Although the aspect can be measured simply, the studies suggested diverse approaches on scoring it. The reason for this diversity is essentially that the studies determine the aspect visually and that the circular structure of the aspect makes the scoring difficult. Also, the score of the aspect value differs according to the study hemisphere and concept. Therefore, the requirement of an objective and easily applicable GIS-based measurement and scoring method of the aspect is genuine. In the study, Maçka Forestry Enterprise, which is located in the Trabzon province of Türkiye, was chosen and the aspect map of the region was obtained. Then, 30 forest roads and 30 landslide areas were selected from the region. The forest roads and landslide areas were evaluated according to their aspect, visually. These visual assessments were scored according to the studies in the literature. After all, the aspect scores of the forest roads and landslide areas were also determined according to the proposed method. This method suggests scoring the aspect in a pixel-wise manner and circular averaging. The results were compared and have shown that the aspect scoring studies in the literature are subjective and contradict each other in many ways. The results also showed that the proposed method is accurate, objective, and effective in measuring and scoring the aspect. Also, the proposed method provides a virtual approach rather than a visual one. Finally, the proposed method is shared as an open-source ArcMap Toolbox to be delivered to the end-user.

Clinical characterization of children and adolescents with ADHD and sleep disturbances.

Sleep disturbances (SD) are commonly reported concerns among parents and caregivers of children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD). While it is widely acknowledged that SD can worsen various aspects of children and adolescents' well-being (e.g., academic performance and emotional/behavioral state), a comprehensive clinical characterization of ADHD and SD is currently lacking. To address this gap, 136 children and adolescents diagnosed with ADHD (aged 6 to 14 years) were retrospectively selected by reviewing electronic health records of hundreds of patients with neuropsychiatric disorders referred to the children's hospital. Participants were divided into two groups based on the presence of SD, assessed via a parent-report questionnaire (94 ADHD without SD and 42 ADHD with SD). Standardized measures of adaptive behavior, academic performance, ADHD-related and emotional/behavioral symptoms were collected. Results documented that the group of ADHD with SD obtained worse scores in specific aspects of adaptive behavior (conceptual and practical domains), academic performance (text comprehension, writing), ADHD symptoms (inattention) and emotional/behavioral difficulties (especially, mood/emotional regulation and stress) compared to those with ADHD without SD. In addition, our results established a relationship between sleep problems and diverse clinical aspects of children and adolescents with ADHD, while controlling for age, cognitive level, gender, ADHD symptoms severity, and Body Mass Index. From a clinical perspective, our study suggests that the presence of SD in patients with ADHD may serve as an indicator for strengths and weaknesses in this population, even demonstrating an independent relationship with specific clinical dimensions. Implications to improve clinical diagnostic and therapeutic interventions are discussed.

The Los Angeles motor scale (LAMS) and ASPECTS score are independently associated with DSA ASITN collateral score.

Mechanical thrombectomy (MT) is the treatment standard in eligible patients with acute ischemic stroke (AIS) secondary to large vessel occlusions (LVO). Studies have shown that good collateral status is a strong predictor of MT efficacy, thus making collateral status important to quickly assess. The Los Angeles Motor Scale is a clinically validated tool for identifying LVO in the field. The aim of this study is to investigate whether admission LAMS score is also associated with the American Society of Interventional and Therapeutic Neuroradiology (ASITN) collateral score on digital subtraction angiography (DSA). We conducted a retrospective multicenter cohort study of consecutive patients presenting with AIS caused by LVO from 9/1/2017 to 10/1/2023 with diagnostically adequate DSA imaging. Demographic, clinical, and imaging data was collected through manual chart review. Both univariate and multivariate analysis were applied to assess associations. A p-value <0.05 was considered significant. A total of 308 patients (median age: 68, IQR: 57.5-77) were included in the study. On multivariate logistic regression analysis, we found that lower admission LAMS score (adjusted OR: 0.82, 95% CI: 0.68-0.98, p < 0.05) and higher ASPECTS score (adjusted OR: 1.21, 95% CI: 1.02-1.42, p < 0.05) were independently associated with good DSA ASITN collateral score of 3-4. Admission LAMS and ASPECTS score are both independently associated with DSA ASITN collateral score. This demonstrates the capability of LAMS to act as a surrogate marker of CS in the field.

ASYMMETRICAL CORTICAL VEIN SIGN (ACVS) PREDICT NEUROLOGICAL AND RADIOLOGICAL IMPROVEMENT IN LARGE AND DISTAL VESSEL OCCLUSION POST REPERFUSION THERAPY

ABSTRACT Purpose To investigate the dynamic changes in ACVS on SWIs in patients who underwent reperfusion therapy and evaluate their association with neurological and radiological improvement Materials and Methods All patients treated for acute ischemic stroke between June 2020 and June 2022, in a single tertiary centre (Hospital Sultan Abdul Aziz Shah) who underwent reperfusion therapy and MRI imaging were retrospectively identified based on clinical and radiology reports. Expected Results This study hypothesizes an improvement in ACVS is expected to correlate with favourable neurological outcomes (MRS at 3 months and NIHSS score) and radiological outcome (DWI / ASPECT scores and Modified Mori score). Conversely, a worsening of ACVS is anticipated to be associated with unfavourable neurological and radiological outcomes. Conclusion Asymmetrical Cortical Vein Signs (ACVS) can serve as a valuable predictor of neurological and radiological outcomes in patients with large and distal vessel occlusion after reperfusion therapy Keywords: ACVS (The Asymmetrical cortical vein sign), Ischemic penumbra , Large vessel occlusion (LVO), Distal vessel occlusion (DVO)

Some minutes matter more: Groin-to-recanalization is the main time-related predictor of outcome in acute ischemic stroke

Introduction Endovascular thrombectomy (EVT) is the standard of care for selected patients with acute ischemic stroke (AIS) and large vessel occlusion (LVO), associated with intravenous thrombolysis, when indicated. While many studies focused on pre-hospital and in-hospital pathways, only few analyzed the relationship between groin-to-recanalization (GTR) time and functional outcome. Aim To explore whether GTR time is an independent predictor of outcome in patients undergoing EVT. Methods All patients with anterior circulation stroke treated with EVT at a high-volume center from January 2021 to December 2023 were included. The cohort was divided into two groups according to GTR time shorter or longer than 30 min. Regression analysis assessed the association between GTR time and 3-month good outcome, defined as modified Rankin Scale 0–2. Results The study included 419 patients. The groups had similar baseline characteristics and similar onset to recanalization (OTR) time. Regression analysis showed shorter GTR time is an independent predictor of favorable outcome (OR 2.49 [95% CI 1.26–4.94]). Age, baseline NIHSS, ASPECT score and bridging IVT were also found to be independently associated with outcome. Discussion and conclusions Our study showed GTR time is an independent predictor of good outcome in patients undergoing EVT with similar OTR time, emphasizing procedural time as a key prognostic factor, even greater than other well-known pre-hospital and in-hospital time-dependent variables. These findings may raise the issue of developing alternative approaches or early “rescue” strategies for complicated procedures.

Penggunaan Model Pembelajaran Numbered Heads Together dengan Permainan Kalimat Berantai dalam Meningkatkan Keterampilan Menulis Teks Fiksi

This study discusses the low interest of students in learning to write fiction texts in influencing the final score to be the background of the research. The purpose of this study is to explore the effectiveness of using the Numbered Heads Together (NHT) learning model with chain sentence games in fictional text writing skills in grade V students of SDN Bangbayang 2. This research method uses a quasi-experimental design for the control group and the experimental group with a total of 15 students in each group. The results showed that the average score of the assessment aspects which included themes, characters, plot, background and language style experienced a significant increase from the experimental group with posttest results (80.00, 89.00, 80.00, 81.33, 88.33) greater than the average score of the pretest (64.33, 71.67, 62.33, 69.67, 74.00). In the control group, the average score obtained during the posttest (77.00, 72.67, 68.67, 74.00 73.67) was also greater than the average score of the pretest (74.00, 70.00, 60.00, 70.33, 69.33), but not as large as the increase obtained by the experimental group. In five aspects of assessment, the analysis of the t-test showed significant t-values (12.67, 14.66, 9.00, 7.99 and 9.99). The conclusion of this study is that the Numbered Heads Together learning model with chain sentence games is effective in improving fiction text writing skills in grade V elementary school students.

Analysis of predictors of hemorrhagic transformation after reperfusion therapy with recombinant tissue plasminogen activator in patients with acute ischemic stroke: a single-center experience

BackgroundHemorrhagic transformation (HT) is a serious complication of thrombolytic therapy for acute ischemic stroke, limiting its indications and affecting treatment plans and clinical prognosis. Identifying risk factors for HT could help improve the risk–benefit ratio of thrombolytic therapy. We aimed to analyze the predictors of HT after reperfusion therapy with recombinant tissue plasminogen activator (rTPA) in patients with acute ischemic stroke. This study included 115 patients who received rTPA. All patients underwent history taking, clinical examination, neurological examination including Glasgow Coma Scale and National Institutes of Health Stroke Scale scores (NIHSS), radiological investigation, and cardiac investigation. Patients were followed up strictly every 2 h for 1st 24 h then for two weeks clinically using the NIHSS and radiologically using CT or MRI to detect HT.ResultsPatients with HT represented 21.7% of all patients receiving rTPA, while symptomatic intracranial hemorrhage (sICH) represented 6.9%. Patients with HT had significantly higher blood pressure, respiratory rate, atrial fibrillation rate, NIHSS score, INR, prothrombin time, neutrophil-to-lymphocyte ratio (NLR), and lower platelet count, LDL level, higher Fazekas score, lower ASPECT score, and prolonged onset-to-needle time.ConclusionPredicting HT in acute ischemic stroke patients is crucial for optimizing management and potentially improving outcomes. In our study, six predictors were associated with HT: higher respiratory rate, higher atrial fibrillation rate, higher NLR, lower LDL level, higher Fazekas score, lower ASPECT score, and onset-to-needle time greater than 180 min.

Post-endovascular therapy contrast extravasation in the mesial temporal region on dual-energy CT is associated with outcome in acute ischemic stroke patients

PurposePre- and post-endovascular treatment (EVT) imaging may aid in predicting functional outcomes in acute middle cerebral artery (MCA) ischemic stroke. Low post-EVT contrast extravasation (CE)-ASPECTS is associated with poor functional outcomes. Besides the MCA regions included in the ASPECTS score, CE may be seen in the mesial temporal (MT) region. In this study, we investigated the frequency and prognostic implication of MT-CE in acute ischemic stroke patients. MethodsPatients with an acute ischemic stroke due to anterior large vessel occlusion who received EVT and post-EVT DECT between 2010 and 2019 were included. Iodine overlay maps of DECT were assessed for the occurrence of CE, using the ASPECTS for occurrence in the MCA region and, calculating a CE-ASPECTS, for whether the MT region was involved. Multivariable linear and logistic regression were used to assess the relationship between involvement of MT-CE and 24-48h NIHSS, mRS, and mortality on a multiple imputed dataset. All models were adjusted significant variables in univariate analyses and for total CE-ASPECTS. Results501/651 patients met the inclusion criteria. MT-CE occurred in 97 (19 %) patients, and was more often present in patients with internal carotid artery occlusions. MT-CE was associated with higher NIHSS scores at 24-hours (aβ 2.2, 95 % CI 0.09-4.31), with increased risk of higher mRS scores (acOR 1.88, 95 % CI 1.16-3.06), and with increased risk of mortality (aOR 2.12, 95 % CI 1.16-3.86). ConclusionMT-CE is a common finding on post-EVT DECT and is an independent predictor for worse functional outcomes.

Investigation of Communities Adaptation and the Role of Landscape Functions in Urban Informal Settlements, Indonesia.

Socio-ecological connectivity highlights the significance of landscape functions as they support communities' resilience in disaster-prone areas. The study aimed to investigate community adaptive capacities in disaster-risk conditions and adopt strategies to reduce vulnerability with the help of landscape functions. Additionally, it intends to examine human-nature relationships by analyzing the perceived importance and performance of each function. Data was collected through questionnaires to obtain residents' perceptions in three sub-districts in Kupang, Indonesia. In addition, two hundred and ninety-four residents were selected as research participants. The results indicate that the overall vulnerability score in three regions is classified as almost vulnerable. Manutapen has high scores in adaptive capacity aspects; however, Airmata has a low score for soil conservation due to the high density of buildings. Respondents in Mantasi and Airmata rely on the provisioning function for daily needs. In Mantasi and Manupaten, the landslide control function is a very high priority. Meanwhile, in Airmata, the main priority should be given to the functions of supporting and regulating. Understanding socio-ecological relationships with attention to the performance of landscape functions is invaluable to supporting sustainable landscape management. It can also ease the pressure of climate change that communities have to contend with.

Understanding healthy ageing in India: insights from multivariate regression trees

BackgroundPopulation ageing represents a significant global challenge, particularly pronounced in countries like India.AimsThis study aims to explore how factors such as socio-economic status, behaviour, and health influence healthy ageing across the Indian older population.MethodsIn this study, we utilized the Longitudinal Ageing Study in India – wave 1 dataset for analysis purposes. Scores were generated for five dimensions of healthy aging, including physical, functional, mental, cognitive, and social aspects and these scores were treated as the target variables. Multivariate Regression Trees analysis was employed to identify the behavioural and socio-demographic factors associated with each dimension of healthy ageing.ResultsYears of education emerge as crucial across all dimensions, positively impacting cognitive health and mitigating age-related decline in healthy ageing. Marital status, engagement in household activities, spiritual practices, and living arrangements impacts the scores of different aspects of healthy ageing. Gender disparities in healthy aging are noticeable in the 60–74 age group, with women generally having lower scores. Safety of the living environment is a crucial determinant of the mental health of the elderly across all age groups.These findings highlight the complex interplay of factors in healthy ageing outcomes.ConclusionOur study emphasizes the pivotal role of education in fostering healthy ageing in India. Factors such as environmental safety and social participation also influence well-being. Targeted interventions addressing education, gender equality, safety, and healthcare access are vital for enhancing the ageing experience and overall well-being of older adults.

Developing Android App-Based Interactive Learning Media for Mechanical Engineering Basics: Enhancing Vocational School Student Learning Outcomes

This study is to provide valid, practical, and effective Android application-based interactive learning media for the Basics of Mechanical Engineering subject in class X Mechanical Engineering at SMK Dhuafa Padang. This medium is intended to boost students' comprehension, motivation, and independence, allowing them to achieve better learning outcomes. The research approach employed is Research and Development (R&amp;D), using a 4D development model (define, design, develop and disseminate). The primary data utilized in this study came from validators, teachers, and students. Data was analyzed descriptively to characterize the validity, practicality and effectiveness of the learning media developed. The validity test findings show that this learning medium, which had a media aspect score of 0,892 and a material aspect score of 0,950, was deemed valid by expert review. This media was also declared practical with a practicality score of 96,94% from teacher responses and 92,25% from student responses. In the effectiveness test, the Gain Score was 0,68, placing it in the medium category. Meanwhile, the t-test shows a Sig value (2-tailed) of 0.002 (2-tailed &lt; 0,05) and a tcount value of 3,372 (tcount ˃ ttable), indicating a significant difference in learning outcomes between students who use this learning media (experimental class) and those who do not use the media (control class). Thus, this Android application-based interactive learning media is declared valid, practical and effective for use in the DDTM learning process.

Implikasi Supervisi Akademik Dalam Meningkatkan Kinerja Guru Di Smp Negeri 1 Ciemas

The purpose of this study is to improve teacher performance through the implementation of academic supervision. The research method used is School Action Research (PTS) with a quantitative descriptive approach. Data collection techniques with observation, interviews, and documentation. Research results shows that academic supervision shows an increase in scores in aspects of learning planning and implementation. Although it is still in the sufficient category, it is because it continues to eventually increase. This result can be achieved because of good cooperation between the Principal and supervised teachers. The Principal discusses with the teacher the problems faced by the teacher in the process of planning and implementing lessons. Academic supervision carried out by the Principal is an effort to improve teaching, including stimulating, selecting the growth of positions and the development of teachers and revising learning objectives, teaching materials, methods, evaluation or assessment of teaching. Academic supervision can help teachers to learn and understand their duties and roles as educators.

Enhancing Students’ Speaking Skills in Speaking for Academic Purposes Subject through Active Debate At The 4th Semester in Academic Year 2023/2024 Universitas Panca Sakti Bekasi

In Speaking for Academic Purposes, the students must be able to speak actively. And there are some materials on this subject, one of them is Debate. Active debate is one way to improve students' speaking skills. So, the purpose of this study was to improve students’ speaking skills through Active Debate. This research method is classroom action research, which is used in two cycles, and each cycle has four steps: planning, action, observing, and reflection. The data presented in this study were obtained from observations, interviews, and students’ speaking scores. The subjects of this research were fifteen students in the fourth semester of the Speaking for Academic Purposes Class at Panca Sakti University. In the study, the researcher got the result, namely the percentage of speaking scores. The score for students speaking test in cycle one was 52.36 % passed, and 47.64 % failed; Passed 78,2% and 21.8% failed in cycle two. So, the increase in yield in cycles 1 and 2 is 25.84%. And score for aspects of observation in cycle one is 71,38% passed and failed: 28,62%; passed 92,5% and 7,5% failed in cycle two. Based on the data above, it can be concluded that learning English, especially speaking through active debate, can improve students’ speaking skills.

Implementasi Budaya Sekolah terhadap Penguatan Profil Pelajar Pancasila pada Siswa Kelas IV SDN 58 Lubuklinggau

The purpose of this study is to describe the Implementation of School Culture towards Strengthening the Profile of Pancasila in Grade IV Students of SD Negeri 58 Lubuklinggau. Through the application of school culture to strengthen the profile of Pancasila students, grade IV students of SD N 58 Lubuklinggau are expected to be able to instill positive values contained in the six main elements of the Pancasila student profile. This research uses a descriptive method with a qualitative research approach because the research describes or describes facts or circumstances regarding factors that affect the strengthening of the profile of Pancasila students at SD Negeri 58 Lubuklinggau. This type of research is descriptive qualitative. The results of research on the implementation of school culture towards strengthening the profile of Pancasila have six kinds of categorization. In the first aspect of the Pancasila, the student profile obtained good categorization with a percentage of 61.05%, in the second aspect obtained sufficient categorization with a percentage of 60.03%, in the third aspect obtained sufficient categorization with a percentage of 60.19%, for the fourth aspect of the Pancasila student profile obtained good categorization with a percentage of 66.29%, in the fifth aspect obtained sufficient categorization to have a percentage of 57.06%, and the sixth aspect obtained sufficient categorization to have a percentage The lowest of the six aspects of the Pancasila profile is with a percentage of 52.25%. From the results of research data analysis, it can be seen that the percentage of scores in various aspects of the Pancasila profile there are several aspects that have a good and sufficient percentage of scores, but the percentage of scores obtained is still in the good category.

Quality of Life Evaluation in Patients with Follicular Cell Lymphoma: A Real-World Study in Europe and the United States.

Follicular lymphoma (FL) is an indolent subtype of non-Hodgkin's lymphoma (NHL), characterized by a long natural course of remissions/relapses. We aimed to evaluate real-world quality of life (QoL) in patients with FL, by line of therapy (LOT), and across countries. Data were drawn from the Adelphi FL Disease Specific Programme™, a cross-sectional survey of physicians and their patients in Europe [France, Germany, Italy, Spain, the United Kingdom (UK)], and the United States (US) from June 2021 to January 2022. Patients provided demographics and patient-reported outcomes via the European Organisation for Research and Treatment of Cancer QoL questionnaire (EORTC QLQ-C30). Bivariate analysis assessed QoL versus NHL, across LOT [first line (1L), second line (2L), third line or later (3L+)] and country. Patients (n=401) had a mean [standard deviation (SD)] age of 66.0 (9.24) years, 58.1% were male, and 41.9%/22.9% were Ann Arbor stage III/IV. Patients with FL mean EORTC global health status (GHS)/QoL, nausea/vomiting, pain, dyspnea, appetite loss, and diarrhea scores were statistically significantly worse (p<0.05) versus the NHL reference values. Mean (SD) GHS/QoL worsened from 1L [56.5 (22.21)] to 3L+[50.4 (20.11)]. Physical and role functioning, fatigue, pain, dyspnea, and diarrhea scores also significantly worsened across later LOTs (p<0.05). Across all functional domains, mean scores were significantly lower (p<0.05) and almost all symptom scores (excluding diarrhea) were significantly higher (p<0.05) for European versus US patients. Patients with FL at later LOTs had significantly worse scores in most QoL aspects than earlier LOTs. European patients had significantly lower functioning and higher symptom burden than in the US. These real-world findings highlight the need for novel FL therapies that alleviate patient burden, positively impacting QoL.

Predictors of hemorrhagic transformation in patients of first ever acute ischemic stroke receiving recombinant tissue plasminogen activator (rTPA)

Abstract Background Hemorrhagic transformation (HT) represents a serious complication of acute ischemic stroke (AIS). Aim To detect predictive factors linked to HT among patients having a first-ever AIS who received recombinant tissue plasminogen activator (rTPA), for better preselection of patients eligible for thrombolytic therapy. Patients and methods This research took place at the Neuropsychiatry Department and Centre of Psychiatry, Neurology, and Neurosurgery, Tanta University Hospitals over 12 months. The total number of patients included was 460, with 115 who received rTPA and 345 who did not receive rTPA. All participants underwent a comprehensive medical history, clinical and neurological assessments, radiological evaluation (ASPECT score), cardiac investigation, and were followed-up for two weeks to detect any HT. Results Patients with HT represented 21.7% of all rTPA patients, with symptomatic intracranial hemorrhage representing 6.9%, while non-rTPA patients with HT represented 13.9% and symptomatic intracranial hemorrhage represented 4.3%. HT patients in the rTPA group had significantly higher rates of smoking, respiratory rate, and lower platelet count, low density lipoprotein and cholesterol levels, while HT patients in the non-rTPA group exhibited significantly higher blood pressure, random blood sugar, as well as lower ASPECT scores. Conclusion There was an association between HT and five predictors (higher smoking rate, higher respiratory rate, lower platelet count, and lower low density lipoprotein and cholesterol levels) in first ever acute ischemic stroke patients receiving rTPA. In patients who did not receive rTPA, HT was associated with lower ASPECT scores, higher blood pressure, and random blood sugar.

The combination of the kaizen approach with the Design of Experiment (DoE) method for improving quality of the bread and donut products in SMEs

Competition for Small and Medium Enterprise (SME) products is currently getting tougher, in terms of quality, timely delivery, and competitive prices. SME customers of bread and donut products sometimes complain about the visual quality of bread and donut products that are stale, burnt, and dirty. The purpose of this research is to reduce product defects during the production process and improve the quality of the bread and donut products. This research method uses a Kaizen approach combined with the Design of Experiment (DoE) one-shoot case study method and uses organoleptic tests to assess the quality of bread and donut products. This study found that there were 3 product defect problems, namely bread and donut defects that did not rise, burnt donut defects, bread defects, and dirty donuts. This research resulted in a decrease in defects of 65% from 3.84% to 1.07%. While the best DoE test results used dough type C with 10 grams fermipan/yeast composition and 15 grams bread improver, stove 165-1750C, equipment cleaning frequency 1 time for each dough, and organoleptic test with 10% beetroot extract addition resulted in a color aspect score of 70 %, 65% aroma aspect, 68.5% texture aspect, and 70% taste aspect which is liked by many people.

Arterial hypotension “magnitude” and neurological outcome during mechanical thrombectomy under general anesthesia

IntroductionMechanical thrombectomy (MT) is the standard of care for the treatment of acute ischemic stroke (AIS) with large vessel occlusion (LVO), but unfavorable outcomes remain common. Procedural arterial hypotension is associated with poor patient outcome. This study aimed to assess the impact of arterial hypotension “magnitude” (a combination of the depth, defined as the percentage relative to baseline arterial blood pressure, and the duration of hypotensive episodes)" during MT on neurological outcome. MethodsThis is a monocentric retrospective study. Charts were reviewed between January 2018 and June 2021. “Patients were eligible if they were 18 years or older, anterior LVO was diagnosed on cerebral imaging” and MT performed under general anesthesia. Mean arterial pressure (MAP) was recorded every 5 min throughout the procedure, and the arterial hypotension “magnitude” was estimated by the area under the curve (AUC) for different thresholds of MAP drops. Main outcome measureThe modified Rankin Scale (mRS) at 90 days. Main resultsAmong the 117 patients analyzed, 46% had poor neurological outcome. Our study showed correlations between poor outcome and a greater procedural AUC of arterial hypotension for the different thresholds: 5% (k 0.18; 95% CI 0.06-0.30; P = 0.007), 10% (k 0.18; 95% CI 0.05-0.30; P = 0.008), 15% (k 0.18; 95% CI 0.04-0.30; P = 0.011), 20% (k 0.18; 95% CI 0.05-0.30; P = 0.010) and 30% (k 0.19; 95% CI 0.05-0.31; P = 0.010). This association persisted after controlling for age, baseline NIHSS score, and ASPECT score. ConclusionThe magnitude of hypotension during MT under general anesthesia for AIS is an independent factor of poor outcome at 90 days. These associations have been observed in patients with mild and severe hypotensive episodes.

Predictors of futile recanalization after endovascular treatment of acute ischemic stroke

ObjectiveEndovascular therapy (EVT) is the most successful treatment for patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) in the anterior circulation. However, futile recanalization (FR) seriously affects the prognosis of these patients. The aim of this study was to investigate predictors of FR after EVT in patients with AIS.MethodPatients diagnosed with AIS due to anterior circulation LVO and receiving EVT between June 2020 and October 2022 were prospectively enrolled. FR after EVT was defined as a poor 90-day prognosis (modified Rankin Scale [mRS] score ≥ 3) despite achieving successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] classification of 2b-3). All included patients were categorized into control group (mRS score < 3) and FR group (mRS score ≥ 3). Demographic characteristics, comorbidities (hypertension, diabetes, atrial fibrillation, smoking, etc.), stroke-specific data (NIHSS score, ASPECT score and site of occlusion), procedure data (treatment type [direct thrombectomy vs. bridging thrombectomy], degree of vascular recanalization [mTICI], procedure duration time and onset-recanalization time), laboratory indicators (lymphocytes count, neutrophils count, monocytes count, C-reactive protein, neutrophil-to-lymphocyte ratio [NLR], monocyte-to-high-density lipoprotein ratio [MHR], lymphocyte-to-monocyte ratio [LMR], lymphocyte-to-C-reactive protein ratio [LCR], lymphocyte-to-high-density lipoprotein ratio[LHR], total cholesterol and triglycerides.) were compared between the two groups. Multivariate logistic regression analysis was performed to explore independent predictors of FR after EVT.ResultsA total of 196 patients were included in this study, among which 57 patients were included in the control group and 139 patients were included in the FR group. Age, proportion of patients with hypertension and diabetes mellitus, median NIHSS score, CRP level, procedure duration time, neutrophil count and NLR were higher in the FR group than in the control group. Lymphocyte count, LMR, and LCR were lower in the FR group than in the control group. There were no significant differences in platelet count, monocytes count, total cholesterol, triglycerides, HDL, LDL, gender, smoking, atrial fibrillation, percentage of occluded sites, onset-recanalization time, ASPECT score and type of treatment between the two groups. Multivariate logistic regression analysis demonstrated that NLR was independently associated with FR after EVT (OR = 1.37, 95%CI = 1.005–1.86, P = 0.046).ConclusionThis study demonstrated that high NLR was associated with a risk of FR in patients with AIS due to anterior circulation LVO. These findings may help clinicians determine which patients with AIS are at higher risk of FR after EVT. Our study can provide a theoretical basis for interventions in the aforementioned population.

Endovascular thrombectomy for acute ischemic stroke with a large infarct area: An updated systematic review and meta-analysis of randomized controlled trials

BackgroundSince the efficacy and safety of endovascular thrombectomy (EVT) in patients with acute ischemic stroke with a large infarct area is still inconclusive, we sought to compare functional and neurological outcomes with the use of endovascular thrombectomy versus medical care alone. MethodsWe searched MEDLINE (via PubMed), Embase, Cochrane Library, ClinicalTrials.gov, and the International Clinical Trials Registry Platform (ICTRP) to retrieve all the relevant randomized controlled trials (RCTs) on this topic. Review manager (RevMan) was used to perform meta-analyses using a random-effect model. Dichotomous outcomes were pooled using risk ratios (RR) with 95% confidence intervals (CIs). ResultsOur meta-analysis included 6 RCTs with a total of 1665 patients. Most studies included patients with an ASPECTS score of 3-5. Our results demonstrate that endovascular thrombectomy significantly increased the rates of functional independence (mRS ≤ 2) (RR, 2.49; 95% CI, 1.89-3.29) and moderate neurological outcome (mRS ≤ 3) (RR, 1.90; 95% CI, 1.50-2.40) at 90 days. The benefit of EVT for these outcomes remained the same at 1-year follow-up. Endovascular thrombectomy was associated with increased rates of early neurological improvement (RR, 2.22; 95% CI, 1.53-3.22), excellent neurological recovery (mRS ≤ 1) (RR, 1.75; 95% CI, 1.02-3.03), and decreased rate of poor neurological recovery (mRS 4-6) (RR, 0.81; 95% CI, 0.76-0.86). No significant difference was found between the two groups regarding all-cause mortality (RR, 0.86; 95% CI, 0.72-1.02), decompressive craniectomy (RR, 1.32; 95% CI, 0.89-1.94), and the incidence of serious adverse effects (RR, 1.39; 95% CI, 0.83-2.32) between the two groups. Endovascular thrombectomy significantly increased the rates of any intracranial hemorrhage (RR, 1.94; 95% CI, 1.48-2.53) and symptomatic intracranial hemorrhage (RR, 1.73; 95% CI, 1.11-2.69). ConclusionEndovascular thrombectomy (EVT) significantly improves neurological and functional outcomes in patients who present within 6 hours of stroke onset with ICA and proximal M1 occlusions, and ASPECTS scores ranging from 3 to 5, compared to medical therapy alone, with an increased risk of symptomatic intracranial hemorrhage.