Count-based Indices Research Articles

Primary and secondary allostatic processes in the context of high-stress work: A multigroup moderation from the English longitudinal study of ageing

Evidence suggests that chronic cortisol excess may precede the development of an allostatic load, and that this association may be influenced by the level of work stress. This study aims to investigate the associations between hair cortisol concentration and the development of systemic allostatic load cross-sectionally and at a lag of four years, stratified by level of effort-reward imbalance.The sample consisted of respondents from the English Longitudinal Study of Ageing (ELSA) who were in employment with hair cortisol measurements at baseline (wave 6), and allostatic load markers at baseline and follow-up (wave 8; n=411; 64 % female). Hair cortisol was used as a measure of total cortisol expression over the preceding two months. Allostatic load was modelled as a count-based index using nine markers; three per system, across the immune, metabolic and cardiovascular systems. This model was then grouped by a median-cut effort reward-imbalance scale (0.83) and regression pathways were compared between groups using a series of Chi-Squared tests of difference.Results provide evidence that higher hair cortisol concentrations predict an increase in immune and cardiovascular allostatic load cross-sectionally, and a metabolic allostatic load at a lag of four years. These pathways were found in the high effort-reward imbalance group, but not in the low effort-reward imbalance group. There were also significant differences found between groups for hair cortisol concentration as a predictor of concurrent immune and cardiovascular allostatic loadFindings may indicate a novel temporality to the accumulation of an allostatic load, and that the “tipping point” between allostasis and allostatic load may lie within the ability of the HPA axis to regulate the cardiovascular system concurrently, with longitudinal consequences for metabolic syndrome indicators.

Systemic immune-inflammation index as a potential biomarker to monitor ulcerative colitis

Objective The treat-to-target strategy is recommended by Selecting Therapeutic Targets in Inflammatory Bowel Disease II (STRIDE-II) for treating ulcerative colitis (UC), and monitoring remission status is crucial during this management. The systemic immune-inflammation index (SII), defined as platelet * neutrophil/lymphocyte, is a complete blood count-based index reflecting the balance of immune and inflammatory status. This study aims to investigate the feasibility of SII for diagnosing UC and monitoring UC disease activity. Methods This study retrospectively analyzed patients with UC and controls. Relationships between SII and Mayo clinical score, Mayo Endoscopic Score (MES), and Nancy Histological Index (NHI) were evaluated. Results 167 patients with UC and 106 controls were included. SII significantly increased in patients with UC and was closely correlated with the Mayo clinical score, MES, and NHI. SII diagnosed UC with a cut-off value of 619.1 × 109/L (area under the curve = 0.861, p < 0.0001, sensitivity 79.64%, specificity 77.36%), evaluated clinical remission status with a cut-off value of 1068 × 109/L (area under the curve = 0.691, p < 0.05, sensitivity 55.71%, specificity 81.48%), endoscopic improvement with a cut-off value of 981.3 × 109/L (area under the curve = 0.819, p < 0.0001, sensitivity 65.22%, specificity 89.66%), and histological healing with a cut-off value of 689.3 × 109/L (area under the curve = 0.898, p < 0.0001, sensitivity 88.89%, specificity 95.83%). Conclusion SII is a potential biomarker for diagnosing UC and monitoring UC disease severity, especially in evaluating mucosal and histological healing during the long-term management in treat-to-target strategy. However, further research is needed to confirm its usefulness and optimize its clinical application.

39. HIGH PREOPERATIVE PLATELET TO LYMPHOCYTE RATIO IS ASSOCIATED WITH A GREATER RISK OF POSTOPERATIVE COMPLICATIONS AND RECURRENCES IN ESOPHAGEAL CANCER

Abstract Background Neoadjuvant treatment is currently the gold standard for advanced esophageal squamous cell carcinoma (ESCC). Several studies have examined the value of blood count-based indexes for predicting short- and long-term outcomes after esophagectomy for ESCC, but the relative predictive value of pretreatment, preoperative, and postoperative indexes has not yet been examined. Methods This study included 320 patients with thoracic ESCC who underwent subtotal esophagectomy after neoadjuvant chemotherapy or chemoradiotherapy at our institution. A total of 19 candidate blood parameters were measured before neoadjuvant treatment as well as preoperatively and postoperatively. The ability of the parameters to predict postoperative complications, overall survival (OS), and relapse-free survival (RFS) were assessed using receiver operating characteristic (ROC) curve analysis and Cox regression analysis. Results ROC curve analysis indicated that preoperative platelet to lymphocyte ratio (PLR) had the best predictive value with an optimal cutoff value of 166. Patients with high preoperative PLR (≥166) had significantly shorter OS and RFS and significantly higher incidences of hematogenous recurrence and postoperative pneumonia compared with patients with low preoperative PLR (&amp;lt;166). In multivariate analysis, high preoperative PLR and high preoperative serum carcinoembryonic antigen level were independent predictors of poor prognosis. Conclusion Preoperative PLR is a good predictor of short- and long-term prognosis in patients with advanced ESCC who receive neoadjuvant treatment followed by radical resection.

High Preoperative Platelet to Lymphocyte Ratio Is Associated with a Greater Risk of Postoperative Complications and Hematogenous Recurrences in Esophageal Squamous Cell Carcinoma Patients Receiving Neoadjuvant Treatment

Introduction: Neoadjuvant treatment is currently the gold standard for advanced esophageal squamous cell carcinoma (ESCC). Several studies have examined the value of blood count-based indexes for predicting short- and long-term outcomes after esophagectomy for ESCC, but the relative predictive value of pretreatment, preoperative, and postoperative indexes has not yet been examined. Methods: This study included 320 patients with thoracic ESCC who underwent subtotal esophagectomy after neoadjuvant chemotherapy or chemoradiotherapy at our institution. A total of 19 candidate blood parameters were measured before neoadjuvant treatment as well as preoperatively and postoperatively. The ability of the parameters to predict postoperative complications, overall survival (OS), and relapse-free survival (RFS) was assessed using receiver operating characteristic (ROC) curve analysis and Cox regression analysis. Results: ROC curve analysis indicated that preoperative platelet to lymphocyte ratio (PLR) had the best predictive value with an optimal cutoff value of 166. Patients with high preoperative PLR (≥166) had significantly shorter OS and RFS and significantly higher incidences of hematogenous recurrence and postoperative pneumonia compared with patients with low preoperative PLR (<166). In multivariate analysis, high preoperative PLR and high preoperative serum carcinoembryonic antigen level were independent predictors of poor prognosis. Conclusion: Preoperative PLR is a good predictor of short- and long-term prognosis in patients with advanced ESCC who receive neoadjuvant treatment followed by radical resection.

Chew-cards can accurately index invasive rat densities in Mariana Island forests

Rats (Rattus spp.) are likely established on 80–90% of the world’s islands and represent one of the most damaging and expensive biological invaders. Effective rat control tools exist but require accurate population density estimates or indices to inform treatment timing and effort and to assess treatment efficacy. Capture-mark-recapture data are frequently used to produce robust density estimates, but collecting these data can be expensive, time-consuming, and labor-intensive. We tested a potentially cheaper and easier alternative, chew-cards, as a count-based (quantitative) index of invasive rat densities in tropical forests in the Mariana Islands, an archipelago in the western North Pacific Ocean. We trialed chew-cards in nine forest grids on two Mariana Islands by comparing the proportion of cards chewed to capture-mark-recapture density estimates and manipulated rat densities to test whether the relationship was retained. Chew-card counts were positively correlated with rat capture-mark-recapture density estimates across a range of rat densities found in the region. Additionally, the correlation between the two sampling methods increased with the number of days chew-cards were deployed. Specifically, when chew-cards were deployed for five nights, a 10% increase in the proportion of cards chewed equated to an estimated increase in rat density of approximately 2.4 individuals per ha (R2 = 0.74). Chew-cards can provide a valid index of rat densities in Mariana Island forests and are a cheaper alternative to capture-mark-recapture sampling when relative differences in density are of primary interest. New cost-effective monitoring tools can enhance our understanding and management of invaded islands while stretching limited resources further than some conventional approaches, thus improving invasive species management on islands.

COMPARISON OF OPTICAL COHERENCE TOMOGRAPHY MEASUREMENTS WITH 3-DIMENSIONAL QUANTITATIVE CORONARY ANGIOGRAPHY-DERIVED COMPUTED FRACTIONAL FLOW RESERVE

Quantitative flow ratio (QFR) is a newly developed 3D quantitative coronary angiography (3D-QCA) and thrombolysis in myocardial infarction frame count-based index for estimating fractional flow reserve (FFR). FFR values correlates with minimum lumen area (MLA) by optical coherence tomography (OCT).

Phase analysis of gated blood pool SPECT for multiple stress testing assessments of ventricular mechanical dyssynchrony in a tachycardia-induced dilated cardiomyopathy canine model

BackgroundStress-induced dyssynchrony has been shown to be independently correlated with clinical outcomes in patients with dilated cardiomyopathy (DCM) and narrow QRS complexes. However, the extent to which stress levels affect inter- and intraventricular dyssynchrony parameters remains unknown. MethodsTen large dogs were submitted to tachycardia-induced DCM by pacing the right ventricular apex for 3–4 weeks to reach a target ejection fraction (EF) of 35% or less. Stress was then induced in DCM dogs by administering intravenous dobutamine up to a maximum of 20 μg·kg−1·min−1. Hemodynamic and ventricular dyssynchrony data were analyzed by left ventricular (LV) pressure measurements and gated blood pool SPECT (GBPS) imaging. In order to assess mechanical dyssynchrony in DCM subjects and compare it with that of 8 normal counterparts, we extracted the following data: count-based indices of LV contraction homogeneity index (CHI), entropy and phase standard deviation, and interventricular dyssynchrony index. ResultsA significant LV intraventricular dyssynchrony (CHI: 96.4 ± 1.3% in control vs 78.6% ± 10.9% in DCM subjects) resulted in an intense LV dysfunction in DCM subjects (EF: 49.5% ± 8.4% in control vs 22.6% ± 6.0% in DCM), compared to control subjects. However, interventricular dyssynchrony did not vary significantly between the two groups. Under stress, DCM subjects showed a significant improvement in ventricular functional parameters at each level (EF: 22.6% ± 6.0% at rest vs 48.1% ± 5.8% at maximum stress). All intraventricular dyssynchrony indices showed a significant increase in magnitude of synchrony from baseline to stress levels of greater than or equal to 5 μg·kg−1·min−1 dobutamine. There were individual differences in the magnitude and pattern of change in interventricular dyssynchrony during the various levels of stress. ConclusionsBased on GBPS analyses, different levels of functional stress, even in close intervals, can have a significant impact on hemodynamic and intraventricular dyssynchrony parameters in a DCM model with narrow QRS complex.

Patients with obesity-related comorbidities have higher disability compared with those without obesity-related comorbidities: results from a cross-sectional study.

The aim of the present study was to describe disability in adult obese patients with obesity-related comorbidities, and to compare it with that of patients without obesity-related comorbidities. Two groups of obese patients were administered a set of 166 International Classification of Functioning, Disability and Health (ICF) categories; on the basis of this set, count-based indexes were developed for each ICF component and difference between patients with and without comorbidities were assessed with independent-sample t-test and Cohen's d as a measure of effect size. ICF categories in which at least 20% of patients reported a problem were considered relevant for describing functioning of obese patients; for each of them, the risk of having obesity-related comorbidities was calculated using odds ratio and 95% confidence interval. A total of 106 inpatients were enrolled in the study: 68 ICF categories reached the 20% threshold, and 31 of them were relevant only among patients with comorbidities. The presence of obesity-related comorbidities was associated with an increased risk of bodily impairments and limitations in performing daily activities. Compared with patients without obesity-related comorbidities, those with comorbidities showed higher disability. Comorbidities contribute to obesity-related disability, and our results support the importance of early rehabilitation interventions to reduce disability.

The risks of learning: confounding detection and demographic trend when using count-based indices for population monitoring.

Theory recognizes that a treatment of the detection process is required to avoid producing biased estimates of population rate of change. Still, one of three monitoring programmes on animal or plant populations is focused on simply counting individuals or other fixed visible structures, such as natal dens, nests, tree cavities. This type of monitoring design poses concerns about the possibility to respect the assumption of constant detection, as the information acquired in a given year about the spatial distribution of reproductive sites can provide a higher chance to detect the species in subsequent years. We developed an individual-based simulation model, which evaluates how the accumulation of knowledge about the spatial distribution of a population process can affect the accuracy of population growth rate estimates, when using simple count-based indices. Then, we assessed the relative importance of each parameter in affecting monitoring performance. We also present the case of wolverines (Gulo gulo) in southern Scandinavia as an example of a monitoring system with an intrinsic tendency to accumulate knowledge and increase detectability. When the occupation of a nest or den is temporally autocorrelated, the monitoring system is prone to increase its knowledge with time. This happens also when there is no intensification in monitoring effort and no change in the monitoring conditions. Such accumulated knowledge is likely to increase detection probability with time and can produce severe bias in the estimation of the rate and direction of population change over time. We recommend that a systematic sampling of the population process under study and an explicit treatment of the underlying detection process should be implemented whenever economic and logistical constraints permit, as failure to include detection probability in the estimation of population growth rate can lead to serious bias and severe consequences for management and conservation.

Primates and Cameras

Field-based primate studies often make population inferences using count-based indices (e.g., individuals/plot) or distance sampling; the first does not account for the probability of detection and thus can be biased, while the second requires large sample sizes to obtain precise estimates, which is difficult for many primate studies. We discuss photographic sampling and occupancy modeling to correct for imperfect detection when estimating system states and dynamics at the landscape level, specifically in relation to primate ecology. We highlight the flexibility of the occupancy framework and its many applications to studying low-density primate populations or species that are difficult to detect. We discuss relevant sampling and estimation procedures with special attention to data collection via photographic sampling. To provide tangible meaning to terminology and clarify subtleties, we use illustrative examples. Photographic sampling can have many advantages over observer-based sampling, especially when studying rare or elusive species. Combining photographic sampling with an occupancy framework allows inference to larger scales than is common in primate studies, addresses uncertainty due to the observation process, and allows researchers to examine questions of how landscape-level anthropogenic changes affect primate distributions.

Household crowding is associated with higher allostatic load among the Inuit

BackgroundHousehold crowding is an important problem in some aboriginal communities that is reaching particularly high levels among the circumpolar Inuit. Living in overcrowded conditions may endanger health via stress pathophysiology....

Comparing count-based and band-based indices of word frequency: Implications for active vocabulary research and pedagogical applications

In assessments of second language (L2) writing, quality of lexis typically claims more variance than other factors, and the most readily operationalized measure of lexical quality is word frequency. This study compares two methods of automatically assessing word frequency in learner productions. The first method, a band-based method, involves lexical frequency profiling, a procedure that first groups individual words into families and then sorts these into corpus-based frequency bands. The second method, a count-based method, assigns a normalized corpus frequency count to each individual word form used, yielding an average count for a text. Both band and count-based methods were used to analyze 100 L2 learner and 30 native speaker freewrites that had been classified according to proficiency level (i.e., native speakers and beginning, intermediate and advanced L2 learners). Machine learning algorithms were used to classify the texts into their respective proficiency levels with results indicating that count-based word frequency indices accurately classified 58% of the texts while band-based indices reported accuracies that were between 10% and 22% lower than count-based indices.

Monitoring Butterfly Abundance: Beyond Pollard Walks

Most butterfly monitoring protocols rely on counts along transects (Pollard walks) to generate species abundance indices and track population trends. It is still too often ignored that a population count results from two processes: the biological process (true abundance) and the statistical process (our ability to properly quantify abundance). Because individual detectability tends to vary in space (e.g., among sites) and time (e.g., among years), it remains unclear whether index counts truly reflect population sizes and trends. This study compares capture-mark-recapture (absolute abundance) and count-index (relative abundance) monitoring methods in three species (Maculinea nausithous and Iolana iolas: Lycaenidae; Minois dryas: Satyridae) in contrasted habitat types. We demonstrate that intraspecific variability in individual detectability under standard monitoring conditions is probably the rule rather than the exception, which questions the reliability of count-based indices to estimate and compare specific population abundance. Our results suggest that the accuracy of count-based methods depends heavily on the ecology and behavior of the target species, as well as on the type of habitat in which surveys take place. Monitoring programs designed to assess the abundance and trends in butterfly populations should incorporate a measure of detectability. We discuss the relative advantages and inconveniences of current monitoring methods and analytical approaches with respect to the characteristics of the species under scrutiny and resources availability.

Disability and profiles of functioning of patients with Parkinson's disease described with ICF classification

The objective of this study was to describe the functional profiles of patients with Parkinson's disease (PD), and the relationships between impairment in body functions, limitations in activities, and environmental factors, using the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). Patients were consecutively enrolled, and the ICF checklist was administered. Two count-based indices were developed: 'extension', containing ICF categories rated with qualifiers 1-4 and 'severity', containing ICF categories rated with qualifiers 3-4. Categories rated with qualifiers 1-4 in at least 50% of patients are described separately. Spearman's correlation analysis was carried out to identify the relationships between impairments in body functions (BF) and body structures, activities and participation, and environmental factors (EF); linear regressions were performed to identify the best predictors of performance indices in activities and participation. A total of 96 patients were enrolled; 34 categories rated with qualifiers 1-4 in at least 50% of patients are reported, and most of them describe impairment in movement-related functions and limitations in mobility and self-care. Performance indices are significantly lower than capacity and significant relationships with both BF impairments and EF are observed. High difficulties in activities and participation performance are connected with both presence of severe BF symptoms and relevant barriers in EF. Both BF and EF play a relevant role in improving functioning of the patients with PD. The connection between EF barriers and severe problems in activities and participation performance suggests the need of fostering participation of patients with PD by promoting facilitators among EFs. Methodologies and tools are needed to couple information on symptoms, on the difficulties in executing activities, and on environmental features.

Disability and functional profiles of patients with migraine measured with ICF classification

To describe the functional profiles of patients with migraine, and the relationships between symptoms, activities and environmental factors, using WHO's International Classification of Functioning (ICF). Patients were consecutively enrolled at the Besta Institute of Milan. The ICF checklist was administered and two count-based indexes developed: 'extension', containing ICF categories rated with qualifiers 1-4, and 'severity', containing ICF categories rated with qualifiers 3-4. Categories rated with qualifiers 1-4 in at least 50% of patients are described separately. Spearman's correlation was performed to identify the relationships between symptoms, activities and environmental factors; linear regressions were performed to identify the best predictors of performance indexes in activities and participation domain. One hundred and two patients joined this study. Twenty-eight categories rated with qualifiers 1-4 in at least 50% of patients are reported: they include difficulties in daily activities, in mobility and in labor activities. Capacity and performance indexes are significantly different. Low correlations are reported between body functions impairments and limitations in activities and participation, slightly higher with capacity indexes. Environmental factors are mildly correlated with capacity indexes. Environmental factors play a relevant role in improving functioning of patients with migraine. Nevertheless, difficulties in activities and participation are explained more by functional impairments than by the effect of environmental factors: in particular, no facilitators target difficulties in work activities or mobility. To plan appropriate interventions that meet patients' needs, especially in the labor sector, methodologies and tools are needed to couple information on symptoms, on the difficulties in executing activities and on environment's features.

Obesity-related disability: key factors identified by the International Classification of Functioning, Disability and Health

Purpose. To identify obese patients' disability features considering the level of body impairments, activity limitations and participation restrictions in relation to environmental factors' effect.Method. Adult obese inpatients (BMI > 35) were enrolled and were administered a set of 166 ICF categories. Count-based indexes were developed for each ICF component: correlations and regression on performance and capacity indexes were performed.Results. Fifty-one patients (62.7% females, mean age 38.1) entered in the study. Description of ICF-based disability components is reported. Capacity is better correlated with body functions (r = 0.619, P < 0.01) and body structures (r = 0.375, P < 0.01) than performance; on the contrary, environmental barriers are correlated better with performance (r = 0.531, P < 0.01) than with capacity. Impairments in body functions and environmental barriers are the best predictors of limitations both in capacity and in performance.Conclusions. Through this multidisciplinary approach, supported by ICFs biopsychosocial model, we described functioning and disability in obese patients, highlighting the strong effect of body functions' impairments and the limited one of environmental factors. This approach can guide rehabilitation programmes, the promotion of positive health outcomes and the modification of patients' lifestyle, not only intended as an issue of barriers' elimination, but as the activation and maintenance of environmental facilitators.

Disability and functional profiles of patients with myasthenia gravis measured with ICF classification

The objective of this study is to describe functional profiles of patients with myasthenia gravis (MG), and the relationships among symptoms, activities and environmental factors (EF), by using WHO's International Classification of Functioning Disability and Health (ICF). Patients were consecutively enrolled at the Besta Institute of Milan, Italy. The ICF checklist was administered and two count-based indices were developed: 'extension', containing ICF categories rated with qualifiers 1-4, and 'severity', containing ICF categories rated with qualifiers 3-4. Spearman's correlation was performed to identify the relationships among symptoms, activities and EF, and linear regressions to identify the best predictors of performance indices in the activities and participation (A and P) domains. One hundred and one patients joined this study. Different values are reported in capacity and performance, the latter being 17.1% less limited in 'extension' and 13% in 'severity' index. Higher correlation indices are observed between A and P and body functions (BFs), than between A and P and EF. Problems in A and P are better explained by BF impairments than by facilitators within EF. In conclusion, EF plays a relevant role in improving MG patients' functioning. Nevertheless, difficulties in A and P, such as lifting objects or doing housework, are explained more by impairments in BF (e.g. in muscle endurance) than by the effect of EF (e.g. drugs and the support of family members). Methodologies and tools are needed to couple symptoms assessment with an evaluation of difficulties in executing activities and the environment's role, to plan appropriate interventions to meet MG patients' needs, especially in the labour sector, as 20% of patients gave up working before the retirement age.

The White Book on disability in Italy: an ICF-based Italian survey

Purpose. To describe the functioning and disability profiles of Italian person with disability (PwD) getting invalidity pension.Methods. Adult subjects were selected within the registries of local health agencies that provide invalidity certificates. The International Classification of Functioning Disability and Health (ICF) checklist was administered by trained interviewers. Count-based indexes were calculated for each ICF chapter and domain. Descriptive analysis and paired-sample t-test for evaluating differences between capacity and performance indexes in Activities and Participation (A&P) were employed.Results. A total of 742 persons were enrolled. Mean age among children and youth (N = 106) was 8.6 years, and among adults (N = 636) was 47.6 years. Most common health conditions are neurological diseases (30.2%), tumors (18.1%) and mental disorders (13.5%). Body Functions and Structures impairments are consistent with sample compositions. In A&P, capacity indexes are higher than performance ones, and facilitators are essentially reported among Environmental Factors (EF).Conclusions. ICF-based tools are adequate to capture difficulties in different A&P areas, and to estimate EF's effect. In our study, the widest difficulties and the widest impact of EF are reported in areas describing activities of daily living, while areas describing communication, employment and leisure time activities are less problematic but, at the same time, less influenced by EF.

ICF in neurology: Functioning and disability in patients with migraine, myasthenia gravis and Parkinson's disease

Purpose. To report and compare functional features of patients with migraine, myasthenia gravis (MG) and Parkinson's disease (PD) with the International Classification of Functioning, Disability and Health (ICF).Method. Adult patients with migraine, MG and PD were enrolled and the ICF checklist administered. Count-based indexes were calculated for each ICF chapter and domain. Indexes were compared across conditions by means of ANOVA; relationships between ICF domains were evaluated using Spearman's correlation; group based on disability status were defined through cluster analysis and compared with disease groups using χ2 test. Finally, most prevalent ICF categories were identified.Results. A total of 300 patients were enrolled and specific differences in BF, BS, A&P and EF indexes are reported. Spearman's correlations reported moderate relationships between BF and A&P indexes, whereas the correlation between A&P and EF is lower. Cluster analysis and χ2 test show that patients with Migraine and MG are more likely to report moderate and low disability, whereas patients with PD are more likely to report moderate or severe disability. A total of 60 ICF relevant categories, mostly from A&P, were identified.Conclusions. Our study provided a description of functioning and disability domains in migraine, MG and PD and enabled to report the impact of EF in determining the actual disability experience.

SPECT de perfusión cerebral en la valoracion pronóstica del ictus

To compare the diagnostic yield of CT scan and perfusion SPECT on admission and its prognostic value in clinical outcome. 25 ischemic stroke cases were studied on admission (<24 h) and at 30-60 days by CT scan, 99mTc-HMPAO-SPECT and neurological scales. Infarct size and severity on SPECT were assessed: visually "Total Weighted Score," added value in 22 areas, and by several semiquantitative count-based indices. Sensitivity: the first CT scan was positive in 24% patients, initial SPECT in 75% (73% of pure subcortical infarcts and 91% of those with cortical involvement). Localization: kappa: 0.725 between SPECT findings on admission and those in control-CT at 5 days. Extent and severity: correlations between count-based and visual indices (r: >0.719), the latter correlated slightly better with clinical scales. Both predicted similarly (Rho>0.739) infarct size in CT diagnostic scan. Early Outcome: There were statistical differences between deceased and survivors in SPECT (<24h) indices and CT-infarct size (mean 5 days), but not in neurological scores on admission. Long term Outcome: Correlation of initial SPECT indices with follow-up functional scores (SNSLP, Barthel index; mean 37 days) was only significant for visual SPECT indices (Rho:0.560 to 0.620). Nevertheless the best predictor of functional status on discharge was the Barthel Index on admission. 1) Early SPECT has good sensitivity and accurate infarct size prediction so it can be a useful tool for deciding thrombolytic therapy; 2) Visual scores perform as well as more complex indices; 3) Infarct volume seems to be a critical determinant in vital outcome; other factors (strategic localization, etc.) might influence long term functional status.