Consistent Protocol Research Articles

Research on Cache Coherence Protocol Verification Method Based on Model Checking

This paper analyzes the underlying logic of the processor’s behavior level code. It proposes an automatic model construction and formal verification method for the cache consistency protocol with the aim of ensuring data consistency in the processor and the correctness of the cache function. The main idea of this method is to analyze the register transfer level (RTL) code directly at the module level and variable level, and extract the key modules and key variables according to the code information. Then, based on key variables, conditional behavior statements are retrieved from the code, and unnecessary statements are deleted. The model construction and simplification of related core states are completed automatically, while also simultaneously generating the attribute library to be verified, using “white list” as the construction strategy. Finally, complete cache consistency protocol verification is implemented in the model detector UPPAAL. Ultimately, this mechanism reduces the 142 state-transition path-guided global states of the cache module to be verified into 4 core functional states driven by consistency protocol implementation, effectively reducing the complexity of the formal model, and extracting 32 verification attributes into 6 verification attributes, reducing the verification time cost by 76.19%.

Effect of Footwear Versus Barefoot on Double-Leg Jump-Landing and Jump Height Measures: A Randomized Cross-Over Study.

Assessing individuals in their own athletic footwear in clinics is common, but can affect movement, performance, and clinical measures. The aim was to compare overall Landing Error Scoring System (LESS) scores, injury risk categorization, specific LESS errors, and jump heights between habitual athletic footwear and barefoot conditions. Randomized cross-over laboratory study. Eighty healthy individuals (55% male) completed the LESS following standard procedures (i.e., land from a 30-cm box to a distance of 50% of body height and then jump upwards maximally). Participants performed the LESS three times in two randomized conditions: footwear and barefoot. LESS data were extracted from 2D videos to compare group-level mean LESS scores, group-level and individual-level injury risk categorization (5-error threshold), specific landing errors, and jump heights between conditions. LESS scores were significantly greater (0.3 errors, p=0.022) and jump heights were significantly lower (0.6 cm, p=0.029) in footwear than barefoot, but differences were trivial (d = 0.18 and -0.07, respectively) and not clinically meaningful. Although the number of high injury-risk participants was not statistically different at a group level (p=1.000); 27 individuals (33.8%) exhibited a clinically meaningful difference between conditions of one error or more in LESS score, categorization was inconsistent for 16.3% of individuals, and four of the 17 landing errors significantly differed between conditions. At a group level, habitual athletic footwear does not meaningfully influence LESS scores, risk categorization, or jump height. At an individual level, footwear can meaningfully affect LESS scores, risk categorization, and alter landing strategies. Use of consistent protocol and footwear is advised for assessing movement patterns and injury risk from the LESS given the unknown predictive value of this test barefoot. Level 3.©The Author(s).

Application of Radiomics in Prognosing Lung Cancer Treated with Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors: A Systematic Review and Meta-Analysis.

In the context of non-small cell lung cancer (NSCLC) patients treated with EGFR tyrosine kinase inhibitors (TKIs), this research evaluated the prognostic value of CT-based radiomics. A comprehensive systematic review and meta-analysis of studies up to April 2023, which included 3111 patients, was conducted. We utilized the Quality in Prognosis Studies (QUIPS) tool and radiomics quality scoring (RQS) system to assess the quality of the included studies. Our analysis revealed a pooled hazard ratio for progression-free survival of 2.80 (95% confidence interval: 1.87-4.19), suggesting that patients with certain radiomics features had a significantly higher risk of disease progression. Additionally, we calculated the pooled Harrell's concordance index and area under the curve (AUC) values of 0.71 and 0.73, respectively, indicating good predictive performance of radiomics. Despite these promising results, further studies with consistent and robust protocols are needed to confirm the prognostic role of radiomics in NSCLC.

Domain Adaptation for Head Pose Estimation Using Relative Pose Consistency

Head pose estimation plays a vital role in biometric systems related to facial and human behavior analysis. Typically, neural networks are trained on head pose datasets. Unfortunately, manual or sensor-based annotation of head pose is impractical. A solution is synthetic training data generated from 3D face models, which can provide an infinite number of perfect labels. However, computer generated images only provide an approximation of real-world images, leading to a performance gap between training and application domain. Therefore, there is a need for strategies that allow simultaneous learning on labeled synthetic data and unlabeled real-world data to overcome the domain gap. In this work we propose relative pose consistency, a semi-supervised learning strategy for head pose estimation based on consistency regularization. Consistency regularization enforces consistent network predictions under random image augmentations, including pose-preserving and pose-altering augmentations. We propose a strategy to exploit the relative pose introduced by pose-altering augmentations between augmented image pairs, to allow the network to benefit from relative pose labels during training on unlabeled data. We evaluate our approach in a domain-adaptation scenario and in a commonly used cross-dataset scenario. Furthermore, we reproduce related works to enforce consistent evaluation protocols and show that for both scenarios we outperform SOTA.

Comparison of the Clinical Efficacy and Safety of Standard and Ultrasound-Assisted Thrombolysis for Pulmonary Embolism: A Systematic Review and Meta-Analysis.

Catheter-directed therapy has been increasingly used in acute pulmonary embolism (PE). Whether ultrasound-assisted thrombolysis (USAT) is superior to standard catheter-directed thrombolysis (SCDT) remains unclear. This is a systemic review and meta-analysis of comparative trials on USAT and SCDT for PE to determine whether either modality yielded better clinical efficacy and safety. Major databases including PubMed, Embase, Cochrane Central, and Web of Science were searched through March 16, 2023. Studies that reported outcomes of SCDT and USAT for acute PE were included. Studies reported data on therapeutic efficacy (a reduction in the right ventricle [RV]/left ventricle [LV] ratio, a reduction in the systolic pulmonary artery pressure [mm Hg], change in Miller index, length of intensive care unit [ICU] and hospital stay) and safety outcomes (in-hospital mortality, overall and major bleeding events). A total of 9 studies with 2610 patients were included in the meta-analysis. The analysis showed significantly greater improvement in the RV/LV ratio in the SCDT group than in the USAT group (mean difference [MD]: -0.155; 95% confidence interval [CI]: -0.249 to -0.006). No statistically significant differences were found between groups comparing change in systolic pulmonary artery pressure (MD: 0.592 mm Hg; 95% CI: -2.623 to 3.807), change in Miller index (MD: -4.1%; 95% CI: -9.5 to 1.3%), hospital stay (MD: 0.372 days; 95% CI: -0.972 to 1.717), and ICU stay (MD: -0.073.038 days; 95% CI: -1.184 to 1). No significant difference was noted in safety outcomes, including in-hospital mortality (pooled odds ratio: 0.984; 95% CI: 0.597 to 1.622), and major bleeding (pooled odds ratio: 1.162; 95% CI: 0.714 to 1.894). In our meta-analysis of observational and randomized studies, USAT is not superior to SCDT in patients with acute PE.INSPLAY registration number: INPLASY202240082. This study compared SCDT and USAT in patients with acute pulmonary embolism. We found no additional benefit in PA pressure change, thrombus reduction, hospital stay, mortality and major bleeding rate. Additional study using consistent treatment protocol is necessary for further investigation.

Spread of Toxoplasma gondii among animals and humans in Northern Italy: A retrospective analysis in a One-Health framework

Toxoplasmosis occurs worldwide and is considered one of the most important food-borne parasitic zoonoses. The consumption of undercooked meat containing viable tissue cysts and ingestion of environmental oocyst are the most important sources of infection. The aim of this retrospective study was to evaluate the spread of Toxoplasma gondii in the province of Bologna (Emilia-Romagna region) in northern Italy, with a One Health approach, comparing seropositivity rates in different animal species and in humans over the last 19 and 4 years respectively. Analyses were performed on serological data collected over different periods at three separate locations: Istituto Zooprofilattico Sperimentale della Lombardia e della Emilia-Romagna (IZSLER); Veterinary University Hospital Clinical Pathology Service, Department of Veterinary Medical Sciences, University of Bologna; and Unit of Microbiology, St. Orsola Hospital, Bologna. Most relevant seropositivity rates observed in animals were 15.5% (wild boar), 25% (roe deer), 18.7% (goat), 29.9% (sheep), 9.7% (pigs), 42.9% and 21.8% in cat and dog, respectively. A comprehensive screening was conducted on a population of 36,814 individuals, revealing a prevalence of 20.4%. Among pregnant women, a frequence of 0.39% for active toxoplasmosis was observed. Despite certain limitations, this study provided valuable insights into the extensive distribution of this parasitic infection among diverse animal species and human populations in the province of Bologna. These findings underscore the importance of implementing consistent and proactive toxoplasmosis screening protocols during pregnancy, while emphasizing the critical need for adopting a One Health approach for effective control of this parasitic disease.

Effect of Impact Parameters on a Unilateral Contusion Model of Spinal Cord Injury in a Virtual Population of Non-Human Primates.

Non-human primate (NHP) spinal cord injury experiments exhibit high intersubject variability in biomechanical parameters even when a consistent impact protocol is applied to each subject. Optimizing impact parameters to reduce this variability through experiments is logistically challenging in NHP studies. Finite element models provide a complimentary tool to inform experimental design without the cost and complexity of live animal studies. A morphologically variable virtual population (N = 10) of NHPs quantified the interaction of morphological variability and different impact conditions in a unilateral cervical contusion, including impactor size (4 and 5 mm) and mediolateral alignment over the cord midline (0.5 and 1 mm). We explored the effect of these conditions on the magnitude and intersubject variability of impact force and cord lateral slippage. The study demonstrated that a 1-mm mediolateral alignment maximized peak forces and minimized lateral slippage. A 5-mm impactor was beneficial in increasing peak forces, whereas a 4-mm impactor reduced lateral slippage. Comparatively, intersubject variability in peak forces and lateral slippage were minimized with a 0.5-mm mediolateral alignment. The study highlights that impact parameters selected based on peak forces may not be beneficial in reducing variability. The study also showed that morphology was an important contributor to variability. Integrating morphology variability through a virtual population in an injury simulation to investigate mechanistic research questions will more effectively capture the heterogeneity of experiments and provide better insights for effective experimental design.

Coordinated Obstacle Avoidance of Multi-AUV Based on Improved Artificial Potential Field Method and Consistency Protocol

Formation avoidance is one of the critical technologies for autonomous underwater vehicle (AUV) formations. To this end, a cooperative obstacle avoidance algorithm based on an improved artificial potential field method and a consistency protocol is proposed in this paper for the local obstacle avoidance problem of AUV formation. Firstly, for the disadvantage that the traditional artificial potential field method can easily fall into local minima, an auxiliary potential field perpendicular to the AUV moving direction is designed to solve the problem that AUVs can easily have zero combined force in the potential field and local minima. Secondly, the control law of AUV formation that keeps the speed and position consistent is designed for the problem that the formation will change during the local obstacle avoidance of the formation system. The control conflict problem of the combined algorithm of the artificial potential field law and the consistency protocol is solved by adjusting the desired formation of the consistency protocol through the potential field force. Finally, the bounded energy function demonstrates system convergence stability. The simulation verification confirmed that the AUV formation could achieve the convergence of the formation state under local obstacle avoidance.

Rhesus macaque fetal and placental growth demographics: A resource for laboratory animal researchers.

Rhesus macaques (Macaca mulatta) are amongst the most common nonhuman primate species used in biomedical research. These animals provide a precious resource for translational studies and opportunities to maximize rhesus data use are encouraged. Here we compile data produced from 10 years of investigator-driven pregnancy studies conducted at the Oregon National Primate Research Center (ONPRC). All pregnancies were generated within the consistent and reproducible protocols of the ONPRC time-mated breeding program. The data included are from control animals who did not experience in utero perturbations or experimental manipulations. A total of 86pregnant rhesus macaques were delivered by cesarean section over a range of gestational days (G) 50 to G159 (where term is G165 ± 10 days in the rhesus macaque), with subsequent immediate tissue harvesting following standardized protocols. Fetal and placental growth measures, and all major organ weights are reported. All data are presented relative to gestational age for the entire cohort and in addition, data are stratified by fetal sex. The outcome is a large reference resource for use by laboratory animal researchers in future comparative fetal development studies.

726 Enteral Tube Clogging and Medication Administration Techniques

Abstract Introduction Many burn patients require long term enteral tube placement. Preventing clogging is essential for patient comfort as well as for preventing pauses in nutritional supplementation required for wound healing. While many studies have been done to measure nursing compliance with policies intended to prevent tube clogging, no research has been done on whether administering pills via enteral tube one at a time with a flush between actually prevents clogs. The purpose of this pilot study was to see if small bore enteral tubes clog more often when medications are given all at once in solution compared to when given individually with a flush between pills. Methods Two enteral tubes were connected to continuous tube feed by pump. The ends were placed in a bucket. Medications were crushed and administered through the tubes. Pills were given through the control one at a time with a flush between, and through the experimental tube all at once in solution. Water flushes were performed before and after medication administration and care was taken that all other conditions were the same between groups. Each med pass was done approximately 24-48 hours apart. If more than gentle, continuous pressure was required to administer the medications and flushes the tube was considered clogged. Results Medications were given through both tubes 36 times. Of the 72 administrations there were 10 clogs, 5 to the control tube and 5 to the experimental tube. Conclusions Results of this pilot study suggest that individually crushing and administering each pill when giving them through an enteral tube does not reduce the incidence of clogs. Considering the time demand and potential for increased fluid intake using this practice we propose giving all medications together in solution as a safe alternative. Especially in the burn population where accurate intake is vital for calculating fluid resuscitation, having a consistent protocol is essential. While the sample size of this study is too small to definitively say there is no difference between medication administration techniques, issues related to fluid and electrolyte balance as well as nursing compliance with policy should be considered when deciding to maintain the current standard of practice which has no basis in evidence Applicability of Research to Practice Administering medications through enteral tubes is a frequent nursing intervention. If applied to practice, these findings would change how nurses are taught to administer medications as well as change the process by which care is delivered on a daily basis.

Chronic motor performance following different traumatic brain injury severity-A systematic review.

Traumatic brain injury (TBI) is now known to be a chronic disease, causing ongoing neurodegeneration and linked to increased risk of neurodegenerative motor diseases, such as Parkinson's disease and amyotrophic lateral sclerosis. While the presentation of motor deficits acutely following traumatic brain injury is well-documented, however, less is known about how these evolve in the long-term post-injury, or how the initial severity of injury affects these outcomes. The purpose of this review, therefore, was to examine objective assessment of chronic motor impairment across the spectrum of TBI in both preclinical and clinical models. PubMed, Embase, Scopus, and PsycINFO databases were searched with a search strategy containing key search terms for TBI and motor function. Original research articles reporting chronic motor outcomes with a clearly defined TBI severity (mild, repeated mild, moderate, moderate-severe, and severe) in an adult population were included. A total of 97 studies met the inclusion criteria, incorporating 62 preclinical and 35 clinical studies. Motor domains examined included neuroscore, gait, fine-motor, balance, and locomotion for preclinical studies and neuroscore, fine-motor, posture, and gait for clinical studies. There was little consensus among the articles presented, with extensive differences both in assessment methodology of the tests and parameters reported. In general, an effect of severity was seen, with more severe injury leading to persistent motor deficits, although subtle fine motor deficits were also seen clinically following repeated injury. Only six clinical studies investigated motor outcomes beyond 10 years post-injury and two preclinical studies to 18-24 months post-injury, and, as such, the interaction between a previous TBI and aging on motor performance is yet to be comprehensively examined. Further research is required to establish standardized motor assessment procedures to fully characterize chronic motor impairment across the spectrum of TBI with comprehensive outcomes and consistent protocols. Longitudinal studies investigating the same cohort over time are also a key for understanding the interaction between TBI and aging. This is particularly critical, given the risk of neurodegenerative motor disease development following TBI.

An Improved Byzantine Fault-Tolerant Algorithm Based on Reputation Model

This study proposes an improved Byzantine fault-tolerant consensus RB-BFT based on the reputation model to address the problems of low reliability of primary nodes and high communication complexity in the practical Byzantine algorithm (PBFT). First, this algorithm establishes a dynamic reputation model of nodes to distinguish honest and malicious nodes in the system, lowering the likelihood of malicious nodes being chosen as primary nodes and increasing the dependability of primary nodes. Second, the algorithm introduces supervisory nodes for information supervision while reducing the centrality of the system. Finally, this algorithm improves the consistency protocol of the PBFT algorithm by optimizing the process of mutual communication between nodes in the preparation and commitment phases, which reduces the algorithm communication complexity from O(n2) to O(n). Theoretical and practical studies reveal that the RB-BFT algorithm enhances performance and reliability greatly.

Platelet-rich plasma and platelet-rich fibrin in oral surgery: A narrative review.

Platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are biological products derived from the plasma fraction of autologous blood that have a platelet concentration above that of the original blood. Cytokines and growth factors are present in platelet-based preparations, and their application has gained great attention in dentistry. The aim of this review was to comprehensively examine the latest scientific evidence on the use of PRF and PRP in oral surgery, and to describe current operational protocols. Platelet-rich fibrin is used after third molar extractions, in the treatment of alveolar osteitis and trismus, and in implant surgery. Platelet-rich plasma is utilized in sinus lift procedures, after tooth extractions, and in patients undergoing the treatment of bisphosphonate-related osteonecrosis of the jaw. Based on this review, plenty of data indicates that the PRF-PRP usage in oral surgery shows promising results. However, no consistent protocols have been presented in the analyzed articles. Further research is needed to provide clinicians with evidence-based clinical recommendations and to develop protocols on the use of these preparations in dental surgery.

Long-term trends and sensitivities of PM2.5 pH and aerosol liquid water to chemical composition changes and meteorological parameters in Hong Kong, South China: Insights from 10-year records from three urban sites

Aerosol pH and aerosol liquid water (ALW) play key roles in regulating many atmospheric processes. In many countries, large reductions in SO2 and NOx emissions as a result of air pollution regulatory policies have led to improved air quality and significant changes in aerosol mass and chemical composition. Understanding the long-term trends and sensitivities of aerosol pH and ALW to changes in meteorological conditions and chemical composition is useful for predicting how atmospheric processes that depend on aerosol acidity and/or ALW will evolve as air pollutant emissions change over time. At present, long-term monitoring records of aerosol pH and ALW are limited in most parts of China and elsewhere in Asia due to the scarcity of long-term aerosol chemical speciation measurements acquired through regular sampling schedules and consistent analysis protocols in this region. We used a 10-year dataset (2011–2020) from three long-term monitoring sites to investigate the long-term trends of PM2.5 pH and ALW concentrations, identify key factors that drive the variations of PM2.5 pH and ALW concentrations, and investigate the sensitivities of PM2.5 pH and ALW concentrations to chemical composition changes during different seasons in Hong Kong, a highly populated urbanized city located in South China that has experienced improved air quality as a result of various effective air pollution regulatory policies. Despite the substantial decreases in PM2.5 concentrations and changes in chemical composition in this 10-year period, PM2.5 pH showed little change. The rates at which PM2.5 pH and ALW concentration changed ranged from −0.007 to −0.001 pH units/year and from −1.45 to −0.53 μg m−3/year, respectively. Clear and consistent seasonal oscillatory cycles were observed for both PM2.5 pH (∼2–∼4) and ALW concentrations (∼5–∼40 μg m−3) at the three sites during this 10-year period. PM2.5 was the most acidic in the fall, and was the least acidic in winter. ALW concentrations were the lowest in summer, and the highest in winter/spring. Sensitivity tests revealed that chemical composition, especially particulate sulfate concentrations, plays a major role in driving the variations in aerosol pH and ALW concentration during each season. However, the magnitudes to which aerosol pH and ALW concentration respond to changes in chemical composition depend strongly on the meteorological conditions in each season. Given that many urbanized cities in South China share similar air quality and meteorological characteristics as Hong Kong, the results presented here are useful for advancing our understanding of how air pollution regulatory policies can alter aerosol pH and ALW concentrations, and consequently aqueous aerosol chemistry, in other South China cities.

Surviving Sepsis Campaign.

Surviving Sepsis Campaign.

Are There Distinct Cardiovascular Subclasses in Acute Respiratory Distress Syndrome? Maybe.

Are There Distinct Cardiovascular Subclasses in Acute Respiratory Distress Syndrome? Maybe.

Transparent and Tamper-Proof Event Ordering in the Internet of Things Platforms

Today, the audit and diagnosis of the causal relationships between the events in a trigger-action-based event chain (e.g., why is a light turned on in a smart home?) in the Internet of Things (IoT) platforms are untrustworthy and unreliable. The current IoT platforms lack techniques for transparent and tamper-proof ordering of events due to their device-centric logging mechanism. In this article, we develop a framework that facilitates tamper-proof transparency and event order in an IoT platform by proposing a Blockchain protocol and adopting the vector clock system, both tailored for the resource-constrained heterogeneous IoT devices, respectively. To cope with the unsuited storage (e.g., ledger) and computing power (e.g., proof-of-work puzzle) requirements of the Blockchain in the commercial off-the-shelf IoT devices, we propose a partial consistent cut protocol and engineer a modular arithmetic-based lightweight proof of work puzzle, respectively. To the best of our knowledge, this is the first Blockchain designed for resource-constrained heterogeneous IoT platforms. Our event ordering protocol based on the vector clock system is also novel for the IoT platforms. We implement our framework using an IoT gateway and 30 IoT devices. We experiment with ten concurrent trigger-action-based event chains while each chain involves 20 devices, and each device participates in five different chains. The results show that our framework may order these events in 2.5 s while consuming approximately 140 mJ of energy per device. The results, hence, demonstrate the proposed platform as a practical choice for many IoT applications, such as smart home, traffic monitoring, and crime investigation.

Impact of Institutional Prophylaxis Guidelines on Rates of Pediatric Venous Thromboembolism Following Trauma - a Multicenter Study from the Pediatric Trauma Society Research Committee.

A paucity of data exists with regard to the incidence, management, and outcomes of venous thromboembolism (VTE) in injured children. We sought to determine the impact of institutional chemoprophylaxis guidelines on VTE rates in a pediatric trauma population. A retrospective review of injured children (<15 years) admitted between 2009-2018 at ten pediatric trauma centers was performed. Data was gathered from institutional trauma registries and dedicated chart review. The institutions were surveyed as to whether they had chemoprophylaxis guidelines in place for high risk pediatric trauma patients, and outcomes were compared based on the presence of guidelines using chi-square analysis (p < 0.05). 45,202 patients were evaluated during the study period. Three institutions (28,359 patients, 63%) had established chemoprophylaxis policies during the study period ("Guidelines"); the other seven centers (16,843 patients, 37%) had no such guidelines ("Standard"). There were significantly lower rates of VTE in the Guidelines group, but these patients also had significantly fewer risk factors. Amongst critically injured children with similar clinical presentations, there was no difference in VTE rate. Specifically within the Guidelines group, 30 children developed VTE. The majority (17/30) were actually not indicated for chemoprophylaxis based on institutional guidelines. Still, despite protocols only one VTE patient in the Guidelines group who was indicated for intervention ended up receiving chemoprophylaxis prior to diagnosis. No consistent ultrasound screening protocol was in place at any institution during the study. The presence of an institutional policy to guide chemoprophylaxis for injured children is associated with a decreased overall frequency of VTE, but this disappears when controlling for patient factors. However, the overall efficacy is impacted by a combination of deficits in guideline compliance and structure. Further prospective data is needed to help determine the ideal role for chemoprophylaxis and protocols in pediatric trauma.Level IV, therapeutic/care management.

Integrated, Coordinated, Open, and Networked (ICON) Scientific and Societal Relevance

AbstractThis article is composed of three independent commentaries about the state and future of Integrated, Coordinated, Open, and Networked (ICON) principles in the Science and Society section of the American Geophysical Union (Goldman et al., 2022, https://doi.org/10.1029/2021EA002099). The ICON approach pioneers a new way of doing science that Integrates physical, chemical, biological, or social attributes across scales, Coordinates with consistent protocols and methods to enable transferability, is Open through the research lifecycle with findable, accessible, interoperable, and reusable principles, and ensures mutual benefit to Network across a broad range of stakeholders. Scientific discoveries, rapid scientific and technological advancements, and solutions improve our ability to face challenges and benefit society. Without innovative approaches and integrity, we cannot solve the challenges of the 21st century, such as educational, agricultural, and health equity as well as climate change and environmental sustainability. Many societal challenges require evolved frameworks and measures to address complex problems. Here, we present three independent commentaries that discuss the connection of science to three broad areas of society and present challenges and untapped opportunities in these areas. The broad areas are Citizen Science, Collaboration across Natural Sciences and Social Sciences, and Education Policy which embody the ICON processes that can create a better understanding of the role of science in society and sustainable development. The ICON processes described in these broad areas offer universal lessons and can be adapted to other areas of impact in society.

Abstract WP151: DISPARI-TICI: Determining If Stroke Patients Assessed For Revascularization Show Ethnic Disparities In TICI Scores Or Complications

Introduction: There is limited data on ethnic disparities in endovascular therapy (EVT) Thrombolysis In Cerebral Infarction (TICI) revascularization scores and EVT complications. The goal of this study was to compare disparities in TICI scores and complications in Hispanic versus Non-Hispanic ethnicities. Methods: We retrospectively examined prospectively collected data from an IRB-approved stroke registry at two academic Comprehensive Stroke Centers (CSC). We included acute ischemic stroke (AIS) patients with large vessel occlusion within 24 hours of last known well that underwent EVT between 1/1/2013-6/30/2022. Favorable outcome was defined as TICI 2b-3. Complications of symptomatic intracranial hemorrhage (sICH), life-threatening or serious systemic hemorrhage, or other serious complication were collected within 36 hours of EVT and compared between Hispanic or Non-Hispanic subjects. Data was analyzed using Chi-squared and was adjusted for baseline NIHSS, blood glucose, and age. A p-value of &lt;0.05 was significant. Results: A total of 411 patients who met study criteria were identified. In Hispanics versus Non-Hispanics, the mean age was 69 vs 70 years, 44.6% vs 48.3% patients were female, and median initial NIHSS was 17 vs 16. The rate of Hispanics in this sample was 29.4% (n=121). There were no differences in baseline characteristics or in patients receiving IV rt-PA prior to EVT between Hispanic and Non-Hispanics (72.6% vs 65.5%; p=0.17). The overall rate of favorable TICI outcome was 93.7% (n=385/411). There was no difference in favorable TICI scores in Hispanic versus Non-Hispanics (96.7% vs 92.4%; p=0.12). Complication rates were also not significantly different in Hispanics versus Non-Hispanics for: sICH (5.8% vs 2.4%; p=0.09), other serious complications (1.7% vs 2.1%; p=0.78), and life-threatening systemic hemorrhage (0.8% vs 0.7%; p=0.88). Conclusion: There were no differences in TICI outcome or complication rates in Hispanic versus Non-Hispanic patients in these 2 academic CSCs. The use of consistent protocols and pathways at a CSC likely contribute to consistent EVT treatment between ethnicities. Further studies must examine EVT outcomes within various ethnicities and races in multiple stroke centers around the country.