Average Number Of Passes Research Articles

Design of Internet Platform for English Teaching in Colleges and Universities under the Background of Big Data

Abstract This paper constructs an English teaching platform based on a speech recognition algorithm and Internet technology, adopts a three-tier architecture to design the web application, and combines the server and browser technology to realize the operation of data interaction with the SQL database. A rectangular bandpass filter is selected for narrow-band information extraction by introducing the sinc function to improve the feature extraction efficiency of speech signals at each frequency. CTC is used to obtain input feature-to-state mapping to solve the sequence problem in speech recognition and achieve end-to-end speech recognition. To achieve the final audio recognition results, the speech decoding algorithm is employed to select the optimal speech output. The results show that in the listening score, the score of the experimental group is 9, and the score of the control is 6. The completion rate of the topics among students who studied on the English teaching platform was higher than that among students who were taught in ordinary English. The completion rate is 0.82 for English questions of grammar type and 0.98 for English questions of listening type, and the average number of passes is the least number of passes, and the number of times is 2.

Abstract 201: Feasibility of an 088” Catheter in the M1 segment for Mechanical Thrombectomy

Introduction Placement of 088” aspiration catheters in the internal carotid artery (ICA) for aspiration in mechanical thrombectomy (MT) has been previously described. However, the use and safety of 088” aspiration catheters beyond the ICA has not been established. Here, we report the utilization and early safety outcomes of 088” catheter placement in the M1 segment for MT. Methods We reviewed a prospectively maintained IRB‐approved database of the senior author to identify consecutive cases where the 088” catheter was navigated to the MCA for use in mechanical thrombectomy. Results We identified 13 cases with placement of an 088” aspiration catheter in the MCA segment (all cases performed in 2023). Average patient age was 71±4 years (range 56‐97 years), with 10 (77%) females, presenting NIHSS was 12±2.1, and 3 (23%) patients received tPA. Location of the thrombus includes 7 (54%) in the M1 and 6 (46%) in the M2. In 13 (100%) cases, the Zoom88 (OD = 2.7 mm, Imperative Care, Campbell, CA) catheter was advanced to at least the M1 segment, and it was used with a coaxial Zoom71 catheter. The average M1 diameter prior to MT was 2.5±0.2mm, 2.3±0.2mm, and 2.2±0.1 in the proximal, mid, and distal M1‐segment, respectively. After MT, the average M1 diameter was 2.4±0.1mm, 2.2±0.1mm, and 2.1±0.2mm in the proximal, mid, and distal M1‐segment, respectively. 85% (n=11) of cases used one or more stentrievers including a Tigertriever, Solitaire, and Trevo. Average number of passes was 1.9±0.2. There were no vessel perforations, catheter‐related dissections, or hemorrhagic complications noted in any case. TICI 2C/3 recanalization was achieved in 100% of cases. The average mRS on discharge was 1.2±0.4. Figure 1. (A) AP angiography demonstrating an M1 branch occlusion (orange). (B) Native view, 088” catheter under aspiration in the MCA (green). (C) Post‐thrombectomy final angiography demonstrating TICI 3 reperfusion. Conclusion The use of large‐bore 088” aspiration catheters in the MCA may offer a safe strategy for direct clot ingestion during mechanical thrombectomy in MCA vasculature that is smaller than the 8‐Fr aspiration catheter.

Abstract 202: Early Experience with the Aristotle Colossus 035” Micro‐Guidewire for Mechanical Thrombectomy: Experience in 6 Cases

Introduction Recent literature continues to demonstrate the successful role large‐bore aspiration catheters have in thrombus ingestion during mechanical thrombectomy. However, the ledge gap, or step off, between the catheter and the microwire can make navigating to distal vasculature difficult. A new 035” micro‐guidewire reduces the step off for 035” aspiration catheters (Aristotle 35 Colossus Guidewire, Scientia Vascular, West Vale City, UT) while maintaining torquability and softness. We report here our early experience in 6 mechanical thrombectomy cases. Methods We reviewed and analyzed a prospectively maintained database of the senior authors to identify cases utilizing a 035” micro‐guidewire with 035” aspiration catheters in mechanical thrombectomy. Results Six consecutive cases of 035” microwire use for mechanical thrombectomy were identified. Four (67%) patients were female with an average age of 77±5.3 years (range 56‐97). Average presenting NIHSS was 11±3. Thrombus locations included 50% (n=3) in the M2, 33% (n=2) in the M1, and 17% (n=1) in the P1. Radial access was performed in 1 case (17%), with remaining via femoral access (n=5, 83%). An 088” ID aspiration catheter was navigated to at least the M1 segment in all anterior circulation cases and the basilar in the posterior circulation case. The 035” wire was placed proximal to the occlusion in all cases allowing coaxial 035” and 071” catheter aspiration passes. The average number of passes was 2±0.3. TICI 2C/3 was achieved in 83% of cases (5/6) and 2b in the remaining case. There were no catheter‐related dissections, perforations, or hemorrhagic complications noted for the cases. Figure 1. (A) AP angiography demonstrating a thrombus in the right M2 superior division (white). (B) 035” (yellow), 071” (orange), and 088” (red) aspiration catheters over the Colossus 35 micro‐guidewire (black) at the level of the thrombus without crossing it. Conclusion The Colossus 035” micro‐guidewire may offer advantages over its narrower counterparts by reducing ledge effect and the need to cross the thrombus. Further comparative studies against currently available microwires are needed in various anatomies to confirm this perceived performance advantage.

Transradial balloon guide catheter placement for acute ischemic stroke thrombectomy: A systematic review and meta-analysis.

Endovascular thrombectomy (EVT) is a treatment option for acute ischemic stroke due to large vessel occlusion. The use of a balloon-guided catheter (BGC) for EVT via transradial access (TRA) has emerged as a treatment approach, but its efficacy and safety compared to existing practices are uncertain. A systematic literature review was performed using Embase, PubMed, Scopus, Web of Science databases, and manual search. Studies reporting safety and efficacy metrics for TRA BGC EVT were included. Data regarding recanalization time, thrombolysis in cerebral infarction (TICI), modified Rankin scale (mRS), symptomatic intracranial hemorrhage (sICH), first pass effect (FPE), and additional complications was pooled using a random-effects model to calculate event rates and 95% confidence intervals (CI). The search yielded five studies (n = 117). The mean time from puncture to final recanalization was 34.5 (95% CI = 30.5 to 39.14, I2 = 0%, P-value = 0.37) min. Successful recanalization (TICI 2b-3) and complete recanalization (TICI 3) occurred in 96.6% (95% CI = 91.24 to 98.71, I2 = 0%, P-value = 0.99) and 55.2% (95% CI = 42.14 to 67.54, I2 = 0%, P-value = 0.39) of cases, respectively. FPE occurred in 67.5% (95% CI = 51.73 to 80.10, I2 = 0%, P-value = 0.56) of patients. mRS 0-2 was achieved in 41.2% (95% CI = 27.34 to 56.65, I2 = 70%, P-value = 0.07) of patients. sICH occurred in 5.0% (95% CI = 1.25 to 17.91, I2 = 0%, P-value = 1.00) of patients. Local complications of radial hematoma and radial vasospasm occurred in 5.0% (95% CI = 0.49 to 12.36, I2 = 29%, P-value = 0.24) and 2.1% (95% CI = 1.25 to 17.91, I2 = 71%, P-value = 0.03) of cases, respectively. Switch to femoral access was necessary in 3.7% (95% CI = 0.00 to 14.07, I2 = 68%, P-value = 0.02) of procedures. The average number of passes per procedure was 1.6 (95% CI = 1.15 to 2.11, I2 = 88%, P-value < 0.001). TRA BGC EVT has potential as a safe and efficacious treatment option compared to existing methods. However, additional, prospective studies are necessary to inform clinical decision making.

Safety and feasibility of a novel bi-directional portal vein access kit during transjugular intrahepatic portosystemic shunt creation

BackgroundTransjugular intrahepatic portosystemic shunt (TIPS) creation remains as one of the more technically challenging endovascular procedures. Portal vein access from the hepatic vein often requires multiple needle passes, which increases procedure times, risk of complications, and radiation exposure. With its bi-directional maneuverability, the Scorpion X access kit may be a promising tool for easier portal vein access. However, the clinical safety and feasibility of this access kit has yet to be determined.Materials and methodsIn this retrospective study, 17 patients (12 male, average age 56.6 ± 9.01) underwent TIPS procedure using Scorpion X portal vein access kits. The primary endpoint was time taken to access the portal vein from the hepatic vein. The most common indications for TIPS were refractory ascites (47.1%) and esophageal varices (17.6%). Radiation exposure, total number of needle passes, and intraoperative complications were recorded. Average MELD Score was 12.6 ± 3.39 (range: 8–20).ResultsPortal vein cannulation was successfully achieved in 100% of patients during intracardiac echocardiography-assisted TIPS creation. Total fluoroscopy time was 39.31 ± 17.97 min; average radiation dose was 1036.76 ± 644.15 mGy, while average contrast dose was 120.59 ± 56.87 mL. The average number of passes from the hepatic vein to the portal vein was 2 (range: 1–6). Average time to access the portal vein once the TIPS cannula was positioned in the hepatic vein was 30.65 ± 18.64 min. There were no intraoperative complications.ConclusionsClinical utilization of the Scorpion X bi-directional portal vein access kit is both safe and feasible. Utilizing this bi-directional access kit resulted in successful portal vein access with minimal intraoperative complications.Level of evidenceRetrospective cohort.

Mechanical thrombectomy in anterior vs. posterior circulation stroke: A systematic review and meta-analysis.

High-quality evidence exists for mechanical thrombectomy (MT) treatment of acute ischemic stroke (AIS) due to large vessel occlusion of the anterior circulation (AC-LVO). The evidence for MT treatment of posterior circulation large vessel occlusion (PC-LVO) is weaker, largely drawn from lower quality studies specific to PC-LVO and extrapolated from findings in AC-LVO, and ambiguous with regards to technical success. We performed a systematic review and meta-analysis to compare the technical success and functional outcomes of MT in PC-LVO versus AC-LVO patients. We identified comparative studies reporting on patients treated with MT in AC-LVO versus PC-LVO. The primary outcome of interest was thrombolysis in cerebral infarction (TICI) ≥ 2b. Secondary outcomes included rates of TICI 3, 90-day functional independence, first-pass-effect, average number of passes, and 90-day mortality. A separate random effects model was fit for each outcome measure. Twenty studies with 12,911 patients, 11,299 (87.5%) in the AC-LVO arm and 1612 (12.5%) in the PC-LVO arm, were included. AC-LVO and PC-LVO patients had comparable rates of successful recanalization [OR = 1.02 [95% CI: 0.79-1.33], p = 0.848). However, the AC-LVO group had greater odds of 90-day functional independence (OR = 1.26 [95% CI: 1.00; 1.59], p = 0.050) and lower odds of 90-day mortality (OR = 0.58 [95% CI: 0.43; 0.79], p = 0.002). MT achieves similar rates of recanalization with a similar safety profile in PC-LVO and AC-LVO patients. Patients with PC-LVO are less likely to achieve functional independence after MT. Future studies should identify PC-LVO patients who are likely to achieve favourable functional outcomes.

The Q and A-The MIVI Q Catheters for Aspiration Thrombectomy-Initial Experience from London.

Background: Aspiration thrombectomy is a widely accepted treatment option for large vessel occlusion (LVO). The MIVI aspiration system has a novel design to maximize the lumen size. We present the results of our initial experience with this innovative aspiration thrombectomy system. Materials and Methods: Retrospectively, we reviewed our database to find all cases of LVO treated with the MIVI Q system (February 2019 and July 2020). In addition, we recorded the baseline demographics, NIHSS, ASPECT, mTICI scores, procedural time, complications, and 90 day mRS. Results: Herein, we identified 25 patients with an average age of 65.3 ± 19.3 years (range 19–89), majority of whom were female (n = 14, 56%). The average NIHSS was 16.9 ± 6.7 (range 6–30), and the average CT ASPECT was 7.9 ± 1.4 (range 5–10). The most common clot location was the M1 segment of the MCA (n = 16, 64%). Four of the patients had tandem lesions (16%). The average clot length was 21.7 ± 31 mm (range 2–130 mm). Of the 23 cases where the Q catheter reached the proximal clot face, mTICI ≥ 2b was achieved on the first pass in 11 cases (44%), and at the end of the ‘Q aspiration’ only the procedures with 16 patients achieved mTICI ≥ 2b recanalization (64%). Stent-retrievers were used in 13 cases (52%). At the end of the procedure, 24 patients (96%) achieved mTICI ≥ 2b with 18 patients (72%) achieving mTICI ≥ 2c. The average number of passes with the Q catheter, including when it was used for SOLUMBRA, was 2.1 ± 2.2 (range 1–10). The mean procedure time was 69 ± 32 mins (range 7–116 mins). No complications were associated with the MIVI Q. Conclusions: The MIVI aspiration system is a novel technology with regards to aspiration mechanical thrombectomy. The system is easy to use with early results comparable to other large-bore catheter systems. However, further studies are needed.

Safety and feasibility of transradial use of 8F balloon guide catheter Flowgate2 for endovascular thrombectomy in acute ischemic stroke.

While Balloon Guide Catheters (BGC) have been shown to increase the rate of reperfusion during mechanical thrombectomy (MT), its implementation with transfemoral approach is at times limited due to unfavorable vascular anatomy. to determine safety, feasibility and performance of the transradial use of 8 F BGC Flowgate2 during mechanical thrombectomy procedures in patients with unfavorable vascular anatomies (type 3 or bovine arch)Material/Methods: We performed a retrospective cohort study of consecutive transradial mechanical thrombectomies performed with BGC Flowgate2 between January and December 2019. Patient demographics, procedural and radiographic metrics, and clinical data were analyzed. 20 (8.7%) out of 230 overall thrombectomy procedures underwent transradial approach using an 8 F BGC Flowgate.2 Successful approach was achieved in 17/20 cases, and in 3 cases radial was switched to femoral, after failure. TICI 2 C/3 was achieved in 18 cases (90%), followed by TICI 2 b and 2a in 1 (5%) case respectively. The average number of passes was 1.8. The average radial puncture-to-first pass time was 22 min. Radial vasospasm was observed in 3/20 cases. The Flowgate2 was found kinked in 4/20 cases (20%), all of them during right internal carotid procedures. There were no postprocedural complications at puncture site, as hematoma, pseudoaneurysm or local ischemic events. The use of 8 F Balloon Guide Catheter during MT via transradial approach might represent an alternative in selected cases with unfavorable vascular anatomies. Its use in right ICA catheterizations was associated with a high rate of catheter kinking.

Safety and Effectiveness of a Modified ASAP Technique during Mechanical Thrombectomy for Acute Ischemic Stroke: Initial Clinical Experience.

Objectives:For patients with acute ischemic stroke, various endovascular approaches have been reported with high recanalization rates and good clinical outcomes. However, the best technique for the first attempt at mechanical thrombectomy remains a matter of debate. In this study, we evaluated the efficacy of a modified version of a stent-retrieving into an aspiration catheter with a proximal balloon (ASAP) technique.Materials and Methods:Modification 1: After stent deployment, the microcatheter was not removed immediately. Modification 2: After the withdrawal of the stent retriever into an aspirator and its removal from the entire system, we focused on the drainage of fluid into a pump. The aspirator was withdrawn slowly until the fluid appeared to be draining continuously into the pump. Before the removal of the aspirator, we performed angiography through the aspirator. We carried out a retrospective analysis of 30 consecutive patients with acute ischemic stroke caused by occlusion of the anterior circulation who were treated with the modified ASAP technique at our institution.Results:A thrombolysis in cerebral infarction score of 2B or 3 was achieved in 29/30 patients (96.7%). The average number of passes was 1.2 ± 0.5. The mean time from puncture to recanalization was 17.6 ± 6.84 min. Twenty-three (76.7%) patients achieved a modified Rankin Scale score of 0–2 at 3 months after the procedure.Conclusions:We found that the modified ASAP technique yielded fast recanalization, minimal complications, and good clinical outcomes of mechanical thrombectomy in this case series.

EUS-FNA, ancillary studies and their clinical utility in patients with mediastinal, pancreatic, and other abdominal lesions.

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is an important modality to obtain tissue diagnosis from mediastinal, pancreatic, and intra-abdominal lesions in close proximity to the pulmonary and gastrointestinal tract. It is considered to be a relatively safe, rapid, and minimally invasive technique with low complication rates. To determine the diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and outcome of EUS-FNA, with histological correlation where applicable. Data of all 1059 consecutive patients who underwent EUS-FNA from 1 January 2005 to 31 December 2017 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore was reviewed in this retrospective study. The major sites that were targeted for EUS-FNA were pancreatic (423), mediastinal (376), and other abdominal lesions (260). The average number of passes per patient was 2.22. Rapid on-site evaluation (ROSE) was adequate in 969 patients (91.4%). Concordance between ROSE and final cytology was 99.5%. Follow-up was available in 810 patients (76.4%). The overall diagnostic yield was 94.3%. Ancillary studies, including immunohistochemical stains and flow cytometry, helped to increase the diagnostic yield from 78.1% to 94.3%. The overall sensitivity, specificity, PPV, NPV, and diagnostic accuracy for EUS-FNA were 94.8%, 98.6%, 99.9%, 65.5%, and 95.1%, respectively. Seven of 1059 patients (0.6%) developed complications. EUS-FNA is a very sensitive and specific diagnostic tool with a minimal complication rate. Ancillary studies helped to increase the sensitivity, as well as the diagnostic yield.

Endoscopic ultrasound guided fine needle aspiration in the diagnosis of intra-abdominal lesions

Background: Endoscopic ultrasound guided fine-needle aspiration cytology (EUS-FNA) in the diagnosis of intra-abdominal lesion is a safe and accurate procedure which is practiced in various parts of the world.12 However, this technique is very new in Bangladesh. To evaluate the diagnostic utility of endoscopic ultrasound guided fine needle aspiration (EUS-FNA) in the diagnosis of abdominal lesions.&#x0D; Methods: EUS-FNA was carried out on a total of ­48 cases during the study period. The lesions were categorized according to the site of FNA. Clinical impression was compared with the final cytological diagnosis and the percentage of non diagnostic smears was calculated.&#x0D; Results: Out of 48 cases, 10 cases (20.8%) were reported as inconclusive while a definite diagnosis was given in 38 cases (79.21%). The mean patient age was 47.68 years. There were 28 (58.33%) males and 20 (41.67%) females. The most common site biopsied was pancreas followed by abdominal lymph node. The average number of passes made was two.&#x0D; Conclusion: Endoscopic Ultrasound Guided Fine-Needle Aspiration in the diagnosis of intra-abdominal lesion is a useful procedure in the evaluation of deep seated lesions of gastrointestinal tract (GIT) and abdominal cavity.&#x0D; Bangladesh Med Res Counc Bull 2019; 45: 41-46

Abstract WP35: A Comparison of Transradial versus Transfemoral Access in Anterior Circulation Mechanical Thrombectomy

Background: The transradial approach (TRA) to endovascular procedures decreases access site morbidity and mortality when compared to the traditional transfemoral technique (TFA). Despite its improved safety profile, there remains concerns that performing mechanical thrombectomy (MT) via TRA may lead to longer revascularization times and thus worse outcomes. However, TRA may confer an added benefit in mechanical thrombectomy (MT) where navigation of challenging aortic arch and carotid anatomy is often facilitated by a right radial artery trajectory. In this study, we compare technical and clinical outcomes in patients who underwent MT via TRA versus TFA. Methods: We performed a retrospective review of our institutional database to identify 51 patients with challenging vascular anatomy who underwent MT for anterior circulation large vessel occlusion between February 2015 and February 2017. Patient characteristics, procedural techniques, and outcomes were recorded and TFA and TRA cohorts were compared. Results: Of the 51 patients, 35% of patients (n=18) underwent MT via TRA. There were no significant differences between the cohorts in patient characteristics, clot location, or aortic arch type and presence of ICA tortuosity. There were no significant differences in technical or clinical outcomes between the 2 cohorts, including rates of single-pass recanalization (54.6% vs. 55.6%, p=0.949) and average number of passes (1.9 vs. 1.7, p=0.453). Mean time from vascular access to reperfusion (61.9 vs. 61.1 mins, p=0.920), rates of successful revascularization (&gt;= TICI2b; 87.9% vs. 88.9%, p=1.0) and functional outcomes (mRS &gt;=2, 39.4% vs. 33.3%, p=0.669) were also similar between the TFA and TRA cohorts, respectively. Conclusions: Our results demonstrate equivalence in efficacy and efficiency between transradial and transfemoral access for MT in acute large vessel occlusion in the anterior circulation in patients with challenging vascular anatomy. Given the established advantage in access-site morbidity, our data suggests that the transradial approach may be superior to the transfemoral approach in well-selected patients undergoing MT.

Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: comparison of technical and clinical outcomes

BackgroundA transradial approach (TRA) is associated with fewer access site complications than a transfemoral technique (TFA).However, there is concern that performing mechanical thrombectomy (MT) via TRA may lead to longer...

Intravenous Administration of Standard Dose Tirofiban after Mechanical Arterial Recanalization is Safe and Relatively Effective in Acute Ischemic Stroke.

To investigate the safety and efficacy of intravenous administration of a standard dose of glycoprotein-IIb/IIIa inhibitor tirofiban after vessel recanalization by mechanical thrombectomy in acute ischemic stroke. A consecutive series of patients (n=112) undergoing endovascular ischemic stroke intervention therapy were enrolled. 81 patients were eligible for intravenous (IV) tirofiban treatment for 24 hours after mechanical thrombectomy. The incidence of symptomatic intracranial hemorrhage (sICH), death, National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) were assessed. In the 81 patients receiving tirofiban, 52 patients (64.2%) were treated with IV rt-PA before mechanical thrombectomy. sICH was found in 2 (2.5%) patients with no fatal ICH. Four patients died during 3 months after stroke onset. Successful recanalization with thrombolysis in cerebral infarction (TICI) score ≥2b was achieved in 75 of 81 patients (92.6%) after mechanical thrombectomy. The average number of passes with Solitaire stent retriever was 1.3. At 3 months, 55 of 81 patients (67.9%) had favorable outcomes (mRS<=2). The intravenous application of a standard dose of tirofiban post-Solitaire stent retriever thrombectomy and intravenous thrombolysis appears to be safe and relatively effective in acute ischemic stroke.

A wearable mixed-reality holographic computer for guiding external ventricular drain insertion at the bedside.

The goal of this study was to explore the feasibility and accuracy of using a wearable mixed-reality holographic computer to guide external ventricular drain (EVD) insertion and thus improve on the accuracy of the classic freehand insertion method for EVD insertion. The authors also sought to provide a clinically applicable workflow demonstration. Pre- and postoperative CT scanning were performed routinely by the authors for every patient who needed EVD insertion. Hologram-guided EVD placement was prospectively applied in 15 patients between August and November 2017. During surgical planning, model reconstruction and trajectory calculation for each patient were completed using preoperative CT. By wearing a Microsoft HoloLens, the neurosurgeon was able to visualize the preoperative CT-generated holograms of the surgical plan and perform EVD placement by keeping the catheter aligned with the holographic trajectory. Fifteen patients who had undergone classic freehand EVD insertion were retrospectively included as controls. The feasibility and accuracy of the hologram-guided technique were evaluated by comparing the time required, number of passes, and target deviation for hologram-guided EVD placement with those for classic freehand EVD insertion. Surgical planning and hologram visualization were performed in all 15 cases in which EVD insertion involved holographic guidance. No adverse events related to the hologram-guided procedures were observed. The mean ± SD additional time before the surgical part of the procedure began was 40.20 ± 10.74 minutes. The average number of passes was 1.07 ± 0.258 in the holographic guidance group, compared with 2.33 ± 0.98 in the control group (p < 0.01). The mean target deviation was 4.34 ± 1.63 mm in the holographic guidance group and 11.26 ± 4.83 mm in the control group (p < 0.01). This study demonstrates the use of a head-mounted mixed-reality holographic computer to successfully perform hologram-assisted bedside EVD insertion. A full set of clinically applicable workflow images is presented to show how medical imaging data can be used by the neurosurgeon to visualize patient-specific holograms that can intuitively guide hands-on operation. The authors also provide preliminary confirmation of the feasibility and accuracy of this hologram-guided EVD insertion technique.

Endoscopic ultrasound-guided fine needle aspiration: A single-center experience from 2010 to 2015

Background and Objectives:Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) allows obtaining adequate material for cytological diagnosis of upper gastrointestinal (GI) lesions that is safe with complication rate ~2%. It is more advantageous over other imaging techniques since it provides real-time imaging and reduction of complications due to the needle proximity to the lesion. Worldwide, data support EUS-FNA in providing cytological diagnosis (80%–95%) with sensitivity and specificity of 90% and 100%, respectively.Methods:This retrospective cross-sectional study included adults who underwent upper GI EUS-FNA from January 2010 to December 2015 at St Luke’s Medical Center, Global City. Blood dyscrasia and history of steroid-, nonsteroidal anti-inflammatory drug- or any anticoagulant-intake were excluded. Medical records were obtained from our databank. Demographics, indications with corresponding success rates, EUS-FNA technique, and complications were reviewed. Frequency, central tendency, variability, and effect measures were used.Results:From the 423 upper GI EUS, 68 patients underwent EUS-FNA (7:1 female:male ratio, mean age 62.1 ± 14.9 years). Mean size (mm) of the lesions observed was 33.3 ± 16.4 (range 4–90). Most frequent location was pancreas (63%), with 81% observed solid lesions (63% adenocarcinoma). Average number of passes is 3 (range 1–6). Indications were cyst aspiration and biopsy of submucosal mass, lymph node, deeper luminal lesions, and solid pancreatic lesions. Success rate ranges 97%–100%. Complication rate was 1.3% as mild pancreatitis. No hemorrhage, perforation, infection, or tumor-seeding was observed.Conclusion:EUS-FNA is a safe and effective diagnostic modality in obtaining definitive histologic diagnosis of upper GI lesions with 97–100% success rate. Complication rate is 1.3%.

Cell block samples from endobronchial ultrasound transbronchial needle aspiration provide sufficient material for ancillary testing in lung cancer-a quaternary referral centre experience.

Rapid on site examination (ROSE) is encouraged at endobronchial ultrasound transbronchial needles aspiration (EBUS-TBNA) to improve diagnostic yield. Due to new therapeutic options in lung cancer, it is not sufficient to merely distinguish between non-small cell lung carcinoma (NSCLC) and small cell lung carcinoma (SCLC). Immunohistochemistry (IHC) distinction is now standard practice, as well as additional molecular testing where clinically indicated. We investigated the diagnostic yield of on-site smears vs. cell block and the provision of cellular material for ancillary testing at our centre. A retrospective audit of all EBUS-TBNA procedures performed until July 2012 was undertaken. Diagnostic yield on smears versus cell block was recorded. Cell blocks were reviewed by an experienced pathologist to determine diagnostic accuracy and whether IHC and molecular testing were possible. In total, 234 procedures were recorded with 101 (43.2%) malignant cases, 107 (45.7%) benign cases and an initial 26/234 (11.1%) insufficient for diagnosis of which 11/234 (4.7%) were false negatives for malignancy after further follow up. The average number of passes was 4.5. For malignancies, smear diagnosis was possible in 95% (96/101) of cases and cell block diagnosis in 93.5% (87/93) of cases. There was sufficient material for IHC in 97.7% (85/87) of malignant cases. In 79.3% (69/87) of NSCLCs molecular testing for epidermal growth factor receptor (EGFR) mutation analysis was theoretically possible on samples obtained. Cell blocks are not inferior to smears for diagnostic accuracy and provide sufficient samples for histology. However, ROSE assists the physician on how best to manage samples for ancillary testing.

Mechanical Thrombectomy for Isolated M2 Occlusions: A Post Hoc Analysis of the STAR, SWIFT, and SWIFT PRIME Studies.

Mechanical thrombectomy is beneficial for patients with acute ischemic stroke and a proximal anterior occlusion, but it is unclear if these results can be extrapolated to patients with an M2 occlusion. The purpose of this study was to examine the technical aspects, safety, and outcomes of mechanical thrombectomy with a stent retriever in patients with an isolated M2 occlusion who were included in 3 large multicenter prospective studies. We included patients from the Solitaire Flow Restoration Thrombectomy for Acute Revascularization (STAR), Solitaire With the Intention For Thrombectomy (SWIFT), and Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment (SWIFT PRIME) studies, 3 large multicenter prospective studies on thrombectomy for ischemic stroke. We compared outcomes and technical details of patients with an M2 with those with an M1 occlusion. All patients were treated with a stent retriever. Imaging data and outcomes were scored by an independent core laboratory. Successful reperfusion was defined as modified Thrombolysis in Cerebral Infarction score of 2b/3. We included 50 patients with an M2 and 249 patients with an M1 occlusion. Patients with an M2 occlusion were older (mean age, 71 versus 67 years; P = .04) and had a lower NIHSS score (median, 13 versus 17; P < .001) compared with those with an M1 occlusion. Procedural time was nonsignificantly shorter in patients with an M2 occlusion (median, 29 versus 35 minutes; P = .41). The average number of passes with a stent retriever was also nonsignificantly lower in patients with an M2 occlusion (mean, 1.4 versus 1.7; P = .07). There were no significant differences in successful reperfusion (85% versus 82%, P = .82), symptomatic intracerebral hemorrhages (2% versus 2%, P = 1.0), device-related serious adverse events (6% versus 4%, P = .46), or modified Rankin Scale score 0-2 at follow-up (60% versus 56%, P = .64). Endovascular reperfusion therapy appears to be feasible in selected patients with ischemic stroke and an M2 occlusion.

Endovascular treatment of severe acute basilar artery occlusion

Severe acute basilar artery occlusion (BAO) has a high mortality rate but as yet no effective treatment has been developed. This study aimed to evaluate the feasibility and safety of combined mechanical thrombectomy, intra-arterial thrombolysis, and emergent stent placement for patients with severe acute BAO. Eighteen patients who were unconscious after confirmed onset of BAO and who were given arterial interventional treatment from March 2011 to June 2013 at our department were included in this study. The mean age was 59.56years (range: 31–76years) and patients were in a critical physical condition upon admission, and had a mean National Institutes of Health Stroke Scale (NIHSS) score of 25.94 (range: 18–35). All patients were treated with mechanical thrombectomy, 10 of whom received mechanical thrombectomy only. Of the others, eight were also treated with intra-arterial thrombolysis, three were treated with emergent stent placement, and 17 were treated with recanalization with an achieved recanalized rate of 94.4%. The average number of passes through the stent was 1.5 (range: 1–3) and five patients died (27.8%). Thirteen patients survived, and the mean NIHSS score was 6.54 (range: 0–16). Seven patients showed a modified Rankin Scale score ⩽2, and the rate of good prognoses was 38.9%. In the treatment of patients with severe acute BAO, intra-arterial mechanical thrombectomy combined with thrombolysis or stent placement are effective strategies to restore blood flow and preserve life, and these strategies have a low incidence of complications.

Extracting physical properties of arbitrarily shaped laser-doped micro-scale areas in semiconductors

We present a method that allows the extraction of relevant physical properties such as sheet resistance and dopant profile from arbitrarily shaped laser-doped micro-scale areas formed in semiconductors with a focused pulsed laser beam. The key feature of the method is to use large laser-doped areas with an identical average number of laser pulses per area (laser pulse density) as the arbitrarily shaped areas. The method is verified using sheet resistance measurements on laser-doped silicon samples. Furthermore, the method is extended to doping with continuous-wave lasers by using the average number of passes per area or density of passes.