ASPECT Score Research Articles

Integrated cost and environmental impact assessment of management options for dredged sediment.

Large quantities of sediment must be dredged regularly to enable marine transport and trade. The sediments are often polluted, with e.g. metals, which limits the management options. The aim of this study has been to assess costs and environmental impacts (impact on climate, marine organisms, etc.) of different management options for polluted dredged sediment, by combining life-cycle assessment (LCA) of the climate impact, scoring of other environmental aspects and a cost evaluation. This approach has been used to study both traditional and new management alternatives for a real port case. The studied options include landfilling, deep-sea disposal, construction of a port area using a stabilization and solidification (S/S) method, and a combination of the aforementioned methods with the innovative option of metal recovery through sediment electrolysis. The LCA showed that deep-sea disposal had the lowest climate impact. The assessment of the other environmental impacts showed that the result varied depending on the pollution level and the time perspective used (short or long-term). Using sediment for construction had the highest climate impact, although other environmental impacts were comparably low. Electrolysis was found to be suitable for highly polluted sediments, as it left the sediment cleaner and enabled recovery of precious metals, however the costs were high. The results highlight the complexity of comparing different environmental impacts and the benefits of using integrated assessments to provide clarity, and to evaluate both the synergetic and counteracting effects associated with the investigated scenarios and may aid early-stage decision making.

Association between hearing impairment, school performance and cognitive function in children and adolescents with sickle cell disease.

To investigate the association among hearing impairment, school performance, and cognitive function in children and adolescents with sickle cell disease. Thirty-one participants with sickle cell disease (SCD) and 31 healthy participants in the control-comparison group (CG), both aged 8-17years underwent auditory system evaluation (pure tone audiometry and acoustic reflex), were screened for the risks of (central) auditory processing disorder and dysfunction of cognitive function using the Scale of Auditory Behaviors (SAB) and the Mini-Mental State Examination (MMSE), respectively, and were interviewed to obtain clinical data and data on school performance. In the SCD group, eight (25.8%) participants presented with sensorineural hearing loss (SNHL). The group with SCD and SNHL presented a higher occurrence of poor school performance than the group of participants with SCD without SNHL (p=0.016). The MMSE score for aspects related to attention and calculation in the SCD group with SNHL was lower than in the SCD group without SNHL (p=0.016). In the SAB, the SCD group with SNHL presented a lower score than the SCD group without SNHL in aspects related to academic performance and attention. Hearing impairment in children and adolescents with SCD, specifically SNHL, is associated with poor school performance and enhances the risk of cognitive impairment in terms of attention and calculation.

Abstract 162: Arterial Aspirate Derived Exosomes From Patients With Large Vessel Occlusion Are Associated With Increased Blood-brain Barrier Permeability, Decreased Endothelial Integrity As Well Poor Clinical And Radiographic Outcomes Following Mechanical Thrombectomy

Introduction: Exosomes (~30-150nm microvessicles [MVs]), are important mediators of cell-cell communication and have been associated with injurious and neuroprotective processes in experimental stroke models. Since many patients treated with mechanical thrombectomy (MT) do not improve despite successful recanalization we hypothesized that these exosomes may mediate injurious processes leading to worse outcomes. Methods: As part of an IRB approved protocol we analyzed arterial blood and retrieved clots aspirated during MT from patients with anterior circulation LVO. MVs were isolated and their effects on BBB permeability and endothelial monolayer integrity measured by transepithelial/endothelial electrical resistance (TEER) in cultured human endothelial cells were measured. Following adjustment for age, DM, NIHSS this effect was also correlated (Pearson R) with NIHSS, RAPID™ CTP parameters, TICI score, BP post MT, 24hr ASPECTS, ICH incidence and mRS. Results: Forty-eight patients were enrolled; mean age was 71±14yrs, 56% were female and 20% were African-American. Mean NIHSS was 16±6.6 with a median baseline ASPECTS score of 9 (range 3-10). Baseline CTP parameters (N=21) were: infarct core 25.8±38.5cc, mismatch volume 103±72.2cc and hypoperfusion index (Tmax>10s/Tmax>6s) 0.34±0.25. Recanalization (TICI 2b/c/3) was achieved in 93.8%. The median 24hr ASPECTS was 7 (range 0-10). At last follow-up 43.5% of patients achieved a good outcome (mRS<=2). BBB permeability was associated with NIHSS change (r=-0.31, p=0.0093), TICI (r=-0.31, p=0.031), SBP post MT (r=0.41, p=0.0036) and 24hr ASPECTS (r=-0.31, p=0.015). TEER correlated most strongly with NIHSS change (r=0.36, p=0.0041), TICI (r=0.35, p=0.02), 24hr ASPECTS (r=0.37, p=0.027) and hypoperfusion index (r=-0.4, p=0.041). Conclusions: Arterial aspirate derived MVs can be isolated from LVO stroke patients. Their effects on BBB permeability and endothelial integrity significantly correlated with clinical and radiographical markers of poor outcomes. It is therefore plausible that clot derived exosomes may impact neurological outcomes following MT through endothelial and BBB injury. In addition, these in vitro BBB measures may serve as biomarkers for post-stroke outcomes.

Abstract TP45: Promoting High Value Care For Stroke Patients Within A Stroke System Of Care: Reducing Unnecessary Hospital Transfers For Patients Not Taken For Thrombectomy

Introduction: High value care aims to provide the best patient outcomes while avoiding defects and waste. Our previous work determined that 39% of patients transferred for possible thrombectomy based on clinical criteria and CT only did not have a large vessel occlusion (LVO) which led to a health system-wide guideline to improve transfer selection by adding criteria for emergent CT angiography. This study aims to describe the impact of that guideline and reanalyze the reasons why patients transferred for consideration of thrombectomy do not receive the procedure. Methods: All patients transferred from within and outside of the health system as a potential thrombectomy candidate between 1/1/19- 6/30/21 were reviewed for reasons why thrombectomy was not pursued. Results: Over 30 months, 316 patients transferred for possible thrombectomy were not taken to the angio suite primarily due to absence of LVO on vessel imaging (26.3%), lack of suspicion of LVO on assessment (18%) and significant improvement in clinical symptoms (12%). Other reasons included too large of core infarct (13.3%), CT head ASPECT score (8.2%), lack of perfusion imaging mismatch (6.3%), poor baseline functional status (4.7%), lesion too distal (3.8%), ICH (3.2%), time since last known well (1.9%), chronic ICA occlusion preventing access to acute lesion (1.9%), and medically unstable (0.3%). Conclusions: Despite the institution of a system-wide protocol for acute CTA imaging to guide patient selection, the major reason for not proceeding to thrombectomy was still absence of LVO, some of which was related to out-of-system hospital transfers. Drawbacks of unnecessary patient transfer include increased cost of care, moving patients farther away from their home and family, and non-essential use of tertiary hospital bed space, particularly in the setting of a pandemic. Given the prevalence of potentially preventable unnecessary transfers, protocols that support in-the-field triage and transport based on clinical criteria alone, without CT or CTA, are destined to worsen health system efficiency and decrease the value of care for patients with major acuteischemic stroke.

Effects of gelatin and preparation methods on the quality and antioxidant of velvet tamarind (Dialium guineense) halal chewy product

Presently, chewy food products are at risk of contamination of non-halal pork gelatin for Muslim consumers. Thus, the sensory study is vital to ensure that products using halal gelatin will have comparable quality. This work was aimed at studying the influence of the formulation and processing of sweet chewy products made from velvet tamarind (VT). The effects of gelatin content from 1.5 to 9% on sensory acceptance were examined. The results revealed that gelatin of 9% was the highest sensory score in all sensory aspects, which were statistically significant differences between the groups studied (p≤0.05). It had an overall liking score of 7.23 (like moderately). A comparison study on sugar ratio and filtration process on physical-chemical properties and sensory acceptance was also conducted. Sensory testing showed that the VT solution content at UVT, ratio 1:1.74 gave the highest average preference score was different significantly from average (p≤0.05). It had an overall liking score of 7.15 (like moderately). The products of best chewy VT found that the moisture content, aw and pH was 4.98%, 0.66 and 3.65, respectively. It was found that the extract contained a substantial amount of antioxidants in the form of vitamin C and phenolic compounds, where the IC50 was evaluated at 53.64 µg/mL. Therefore, the quality of the halal sweet chewy products was found to be acceptable by the sensory evaluation of panel members.

Continuous passive motion not affect the knee motion and the surgical wound aspect after total knee arthroplasty

BackgroundThis study aimed to assess whether use of continuous passive motion (CPM) could improve range of motion in patients after total knee arthroplasty (TKA), if it could affect the surgical wound aspect (SWA) and if it could influence on pain management after TKA.MethodsWe randomized 210 patients in two groups, 102 patients in the CPM group, who received a standard rehabilitation protocol together with CPM application; and 108 patients in the no-CPM group, without CPM. Variables as knee motion (flexion, extension, range of motion) and pain were measured before surgery, on the 1st, 2nd and 3rd postoperative day, and in the 2nd, 6th, 12th and 24th postoperative weeks following TKA. The SWA was determined by the “surgical wound aspect score” (SWAS) in the next 48 h after surgery. This scale analyzes swelling, erythema, hematoma, blood drainage and blisters.ResultsThere was an improvement in the knee motion over the course of follow-up in both groups, without significant difference in flexion parameter. We found no significant differences in the total score of SWA, except for hematoma, with less severity in the CPM group. Furthermore, we found no differences in the others SWAS parameters and pain.ConclusionsThe application of CPM does not provide benefit to our patients undergoing TKA in terms of either improved flexion mobility or decreased pain. No relationship was found between the use of CPM and the global score of SWA following a TKA, except for a decrease in hematoma appearance.

The Effect of Combination Use of Hemodialysis and Hemoperfusion on Microinflammation in Elderly Patients with Maintenance Hemodialysis

Background: Patients with maintenance hemodialysis (MHD) generally have a microinflammatory state. The aim of this study was to investigate the effects of hemodialysis (HD) combined with hemoperfusion (HP) on microinflammatory state in elderly patients with MHD. Methods: One hundred and fifty elderly patients with MHD were randomly divided into the control group and the observation group. The control group received simple HD treatment, and the observation group received combined HD + HP treatment on the basis of the control group. After 6 months of continuous treatment, the patients were evaluated to compare the quality of life, inflammation, adverse reactions, and nutritional indicators in the 2 groups before and after treatment. Results: There was no significant difference in the quality of life between the 2 groups before treatment. After treatment, the scores of psychological aspects, physiological aspects, social aspects, environmental aspects, and independent ability in the observation group were higher than those in the control group, with statistical significance (p < 0.05). There was no statistical significance in the level of inflammation between 2 groups before treatment. After treatment, the levels of hs-CRP, Hcy, IL-6, and TNF-α in the observation group were significantly lower than those in the control group, with statistical significance (p < 0.05). The incidence of dry mouth, skin reaction, neuritis, and subcutaneous tissue fibrosis in the observation group was lower than that in the control group, with statistical significance (p < 0.05). There was no statistical significance in nutritional level indexes between 2 groups before treatment (p₁ > 0.05). After treatment, the levels of hemoglobin, total protein, albumin, and transferrin in the observation group were significantly higher than those in the control group, with statistical significance (p < 0.05). Conclusion: The clinical effect of HD combined with HP in elderly MHD patients is significant, which can effectively reduce the incidence of adverse reactions and inflammation in the patients and improve the quality of life and nutritional indicators of the patients.

Quality of Life After Stereotactic Body Radiation Therapy Versus Conventional Radiation Therapy in Patients With Bone Metastases

Painful bone metastases hamper quality of life (QoL). The aim of this prespecified secondary analysis of the PRESENT trial was to compare change in global QoL, physical functioning, emotional functioning, functional interference, and psychosocial aspects after conventional radiation therapy (cRT) versus stereotactic body RT (SBRT). A total of 110 patients were enrolled in the phase 2 randomized controlled VERTICAL trial (NCT02364115) following the "trials within cohorts" design and randomized 1:1 to cRT or SBRT. Patient-reported global QoL, physical functioning, emotional functioning, functional interference, and psychosocial aspects were assessed by the European Organization for Research and Treatment of Cancer QoL Questionnaire (QLQ) Core 15 Palliative Care and QLQ Bone Metastases 22 modules. Changes in QoL domains over time were compared between patients treated with cRT and SBRT using intention-to-treat (ITT) and per-protocol (PP) linear mixed model analysis adjusting for baseline scores. Proportions of patients in the cRT versus SBRT arm reporting a clinically relevant change in QoL within 3 months were compared using a χ2 test. QoL scores had improved over time and were comparable between groups for all domains in both the ITT and PP analyses, except for functional interference and psychological aspects in the ITT. Functional interference scores had improved more after 12 weeks in the cRT arm than in the SBRT arm (25.5 vs 14.1 points, respectively; effect size [ES]=0.49, P=.04). Psychosocial aspects scores had improved more after 8 weeks in the cRT arm than in the SBRT arm (12.2 vs 7.3; ES=0.56, P=.04). No clinically relevant differences between groups at 12 weeks in terms of global QoL, physical functioning, emotional functioning, functional interference, and psychosocial aspects were observed. Palliative RT improves QoL. Both SBRT and cRT have a comparable effect on patient-reported QoL outcomes in patients with painful bone metastases. Functional interference and psychological aspects scores improved more in patients treated with cRT versus patients offered SBRT.

Changes of prominent vessel sign and susceptibility vessel sign in acute ischemic stroke patients with and without successful recanalization: a study based on susceptibility weighted images

ABSTRACT Objectives To investigate the changes of prominent vessel sign (PVS) and susceptibility vessel sign (SVS) in acute ischemic stroke (AIS) patients with successful and non-successful vascular recanalization treatment, and to study the associations between the susceptibility-weighted imaging (SWI) findings and early clinical and imaging prognosis. Methods Thirty-five patients with the acute MCA territory infarction were retrospectively included and classified into Groupre (n = 25) and Groupnon (n = 10) according to the success of vascular recanalization. NIHSS was used for clinical assessment. PVS and DWI were analyzed using ASPECT scores. Baseline, post-treatment, the changes of PVS and SVS, and SVS length were recorded and compared between two groups. Correlation analysis was performed between SWI factors and early post-treatment clinical and imaging factors. Results The mean PVSpre value was 5.20 ± 1.76 and PVSpost was 8.20 ± 1.86. PVSpre and PVSpost showed statistical significance between Groupre and Groupnon (both p < 0.001). A significant difference wasfound in SVSpost(+) (p < 0.001), SVSpost-pre(+) (p = 0.001), SVSpost-pre length (p = 0.036) and SVSpost length (p = 0.001) between the two groups. A positive correlation was found between PVSpre and DWIpost (p < 0.001, r = 0.564). There were positive correlations between PVS-DWI mismatch and NIHSSpost in Groupre (p = 0.042, r = 0.410) and in Groupnon (p = 0.006, r = 0.789). Conclusions PVS and SVS changes are influenced by the success of vascular recanalization. However, the changes are unrelated to either early clinical or imaging outcomes in AIS patients. PVS-DWI mismatch can be taken as an imaging biomarker for early clinical outcomes, both for patients with or without successful vascular recanalization.

Clinical effect and prognostic factors of mechanical thrombectomy in the treatment of acute ischemic stroke.

Objectives:To explore the clinical effect and prognostic factors of mechanical thrombectomy in the treatment of acute ischemic stroke.Methods:The records of patients with acute ischemic stroke treated in our hospital from April 2020 to April 2021 were retrospectively selected. A total of 65 patients were treated with mechanical thrombectomy. After treatment, they were scored with modified Rankin Scale (MRS). The treatment effect and prognostic factors were analyzed.Results:The occluded vessels were successfully opened in 65 patients. The recanalization rate was 96.92%. There were no serious complications of thrombectomy. The time from femoral artery puncture to vascular recanalization was (84.06±16.64) minutes and the number of thrombectomies was (2.52±0.71). There were 42 patients with good prognosis and 23 patients with poor prognosis. Analysis of the prognostic factors showed that the time from onset to admission in the good prognosis group was shorter, the NIHSS score before thrombectomy was higher, and the Alberta stroke program early CT Score (ASPECT) score was lower as compared to the patients in the poor prognosis group. The grade of vascular recanalization in the good prognosis group was better than that in the poor prognosis group, and the level of PCT was lower (P<0.05). Logistic regression analysis showed that the time from onset to admission, NIHSS and ASPECT scores before thrombectomy were the prognostic factors of mechanical thrombectomy in the treatment of acute ischemic stroke.Conclusion:Mechanical thrombectomy is effective in the treatment of acute ischemic stroke and can effectively promote the recanalization of occluded vessels, but the NIHSS and ASPECT scores from the onset to the time of admission before thrombectomy can directly affect the prognosis of patients.

Work-related accidents, musculoskeletal pain, and health-related quality of life among Pantanal farm workers in Brazil and ganaderos in Mexico.

IntroductionThe agricultural and livestock production of Brazil and Mexico stand out in the global scenario. In this context, this economic activity is one of the most vulnerable, presenting alarming incidence and prevalence rates of work-related accidents and diseases.ObjectivesThis study characterized and compared the occurrence of occupational accidents and musculoskeletal pain, as well as the health-related quality of life of Pantanal farm workers (pantaneiros) in Brazil and their equivalents in Mexico - the ganaderos. This study included 100 farm workers of the Brazilian municipality of Aquidauana, state of Mato Grosso do Sul, and the Mexican municipality of Atemajac the Brizuela, state of Jalisco.MethodsThe research instruments used in this study were the Nordic Musculoskeletal Questionnaire, a questionnaire on occupational accidents in rural areas, a sociodemographic and occupational questionnaire, and the Medical Outcomes Study 36-Item Short-Form Health Survey.ResultsAmong the participants, 84% of the Brazilians and 90% of the Mexicans suffered some type of accident; 48% of the Brazilians and 28% of the Mexicans reported lower back pain; and 36% of the Brazilians and 42% of the Mexicans reported knee pain. Both the Brazilian and Mexican workers had the best score (90.6) for emotional aspects of health-related quality of life, in contrast with their worst scores: pain (19.4 for Brazilian workers, 13.8 for Mexican workers).ConclusionsThese indicators imply that these workers are exposed to risks of accidents, pain, and illnesses that interfere with their health-related quality of life.

Advances in Stroke: Treatments-Interventional.

Advances in Stroke: Treatments-Interventional.

Valuation of automatized ASPECTS as an artificial intelligence tool in daily clinical

To evaluate an automated ASPECTS (ASPECTS-a) software against two radiologists' reading of CT scans requested from the Emergency Department. Describe the most frequent failures of the ASPECTS-a. All the cranial CT Scans requested by the Emergency Department in one month were collected. The following data were recorded: age, sex, the reason for requesting the study, and imaging findings. A program was used that provides an ASPECTS score automatically. Subsequently, 2 radiologists independently reviewed all of the studies and provided the visual ASPECTS (ASPECTS-v). In case of discrepancy, a new reading was made by consensus. A total of 295 brain CT scans (45.1% male) with a mean age of 65 ± 20.0 years were included. 91.8% were interpreted as ASPECTS-v 10 in both cerebral hemispheres by both readers. ASPECTS-a scored 45% with ASPECTS 10 in both cerebral hemispheres. In 152 (51.5%) the ASPECTS-a and the ASPECTS-v did not coincide. The causes of the discrepancy were mainly due to segmentation errors (usually due to asymmetric atrophies). Most of the segmentation errors were located in the head of the caudate nucleus, observed in 60 studies. ASPECTS-a is a powerful and helpful tool, but human supervision is always necessary, particularly in groups of patients with pre-existing brain changes.

Prognostic factors of cerebral revascularisation in acute ischemic stroke at Hanoi Heart Hospital

Background: Considering the effectiveness of treatment for acute ischemic stroke (AIS)patients, the most expected method is immediate revascularization using intravenous thrombolysis or mechanical thrombectomy, or both methods. Objective: “Find factors related to post-treatment outcomes of acute ischemic stroke patients undergoing cerebral revascularization”. Method: Cross-sectional, prospective, descriptive analysis with convenient sample size. Results: From February 2018 to August 2021, 83 patients were hospitalized with a diagnosis of acute ischemic stroke or acute ischemic stroke and had cerebral revascularision either by thrombolysis or mechanical devices or both. 6.02% of them had cerebral thrombosis with mechanical devices and stenting of cerebral/carotid arteries. Mean age was 66.37±11.82 (range 31to 91 years). Mean NIHSS score was 12.57±6.70. The rate of complete recanalization was 91.56%. The mRS score of 0-2 points accounted for 48.19% at the time of discharge and 54.21% at 30 days after discharge. The rate of death or severe illness at discharge accounted for 14.45%. 30 days all-cause mortality after discharge accounted for 25.3%. Conclusion: The rate of complete reperfusion in patients with acute cerebral infarction at Hanoi Heart Hospital and good recovery rate is quite high. Factors that related to the treatment efficacy of patients with acute ischemic stroke were NIHSS score, ASPECT score, occlusion site, pre-reperfusion parenchymal damage and the selection of appropriate reperfusion measures.

Association between serum concentrations of anti-apoptotic B-cell lymphoma-2 protein and traumatic brain injury mortality

ABSTRACT Background There are scarce and contradictory data existing about B-cell lymphoma 2 (Bcl2), one of the Bcl2 family of anti-apoptotic proteins, in traumatic brain injury (TBI) patients. Thus, the objective of this study was to analyze whether blood concentrations of Bcl2 are associated with mortality. Methods Patients with isolated and severe TBI, defined as <10 points of the Injury Severity Score (ISS) in non-cranial aspects and <9 points in Glasgow Coma Scale (GCS), were included. This was an observational and prospective study carried out in five Intensive Care Units. Serum Bcl2 concentrations on day 1 of TBI were determined. Results Serum Bcl2 concentrations were lower (p < 0.001) in surviving patients (n = 59) compared to non-survivors (n = 24). We found an association between serum Bcl2 levels and mortality controlling for age and GCS (OR = 1.149; 95% CI = 1.056–1.251; p = 0.001) and controlling for computer tomography findings (OR = 1.147; 95% CI = 1.056–1.246; p = 0.001). Conclusions This study reports for the first time an association between serum Bcl2 levels and 30-day mortality in TBI patients.

Children participating in after-school programs in Chile: Subjective well-being, satisfaction with free time use and satisfaction with the program

This article analyzes the subjective well-being and satisfaction with the use of free time of 1,033 Chilean children (49.1% girls) aged 9 to 14 years of whom 568 attend a public after-school Program and 465 do not. The satisfaction levels of participants in the Program are also assessed. All of the children are living in contexts of high social vulnerability, and they attend municipal schools. Well-being scales previously validated in Chile and free-time use items internationally used were applied here. The scales' fit and score equivalence between groups were evaluated with a confirmatory factor analysis and multi-group structural equations analysis. The overall results show that children in both groups presented high levels of subjective well-being. Although the majority of those attending the Program had higher scores, the differences did not reach statistical significance. With the more specific analysis, the children attending the Program showed significantly higher scores in some subjective well-being aspects. They also felt happier and more satisfied with their use of free time compared to the group not attending the Program. The results also indicated high satisfaction with the Program, a significant correlation between Program participation, and a greater diversity of activities pursued outside of the classroom. The impact of socio-demographic variables such as age and gender were analyzed using multiple regression. The effect of public initiatives on children's well-being is discussed in light of the scant research currently available in the field. Two other points are discussed as well. Specifically, the results of this research may add to the knowledge around child subjective well-being. The use of subjective well-being indicators when evaluating public policies in support of childhood is also addressed.

Updating estimates of the number of UK stroke patients eligible for endovascular thrombectomy: incorporating recent evidence to facilitate service planning.

IntroductionEndovascular thrombectomy (EVT) is a highly effective treatment for acute ischaemic stroke due to large arterial occlusion (LAO). To support decisions about service provision, we previously estimated the annual UK population eligible for EVT as ∼10% of stroke admissions. Since then, several trials have produced evidence that could alter these figures. We update our estimates considering information from studies and trials reporting 2018–2021 on incidence, presentation time and stroke severity and consider the possible impact of predicted demographic changes in the next 10–20 years.Patients and MethodsWe produce an updated decision tree describing the EVT eligible population for UK stroke admissions. One-way sensitivity analyses (using upper and lower confidence intervals for estimates at each branch of our decision tree) were used to identify where further research evidence is necessary to increase certainty around estimates for numbers of EVT eligible patients.ResultsThe updated estimate for the number of UK stroke patients eligible for EVT annually was between 10,020 (no advanced imaging in early presenting patients) and 9,580 (advanced imaging in all early presenting patients), which compared with our estimates in 2017 is a minimal reduction. One-way sensitivity analyses established that enhanced evidence about eligibility for milder strokes, ASPECTS scores and pre-stroke disability are offset by evidence regarding a lower incidence of LAO. Importantly, predicted increases in life expectancy by 2040 may increase thrombectomy need by 40%.DiscussionInformation from additional randomised trials published during 2018–2020 with updated estimates of LAO prevalence had a minimal impact on overall estimates of stroke patients eligible for EVT in the UK. Ongoing research into the benefits of EVT for patients with mild stroke or European Stroke Journal For Peer Review lower ASPECTS scores has the potential to increase the estimates of the eligible population; future need for EVT will increase with the ageing population.ConclusionOur updated analyses show overall numbers eligible little changed, but evidence from ongoing trials and demographic changes have the potential to increase the need for EVT significantly.

A WRITING SKILL ASSESSMENT OF THE FIRST SEMESTER ENGLISH DEPARTMENT STUDENTS OF THE UNIVERSITAS SUMATERA UTARA

This study attempts to measure the students’ abilities in writing through online language learning platform using library research. The subject of the research was TOEFL top score in English Department USU consisting of 19 students. The instruments of collecting data were the students’ writing e-portfolio as the quantitative and qualitative data. Based on the assessment process, the used of online learning platform was very helpful, effective, and efficient both for the teachers and the students. The findings of the research: (1) Content aspect score was 25.7; (2) Organization aspect score was 18.1; (3) Vocabulary aspect score was 18.3; (4) Language use aspect score was 19.7; (5) Mechanics aspect score was 4.3. The result of the research showed that the students experienced mostly in excellent to very good level.

CORRELATION OF DIFFUSION WEIGHTED MR DETERMINED INFARCT VOLUME WITH ALBERTA STROKE PROGRAM EARLY COMPUTED TOMOGRAPHY SCORE IN ACUTE STROKE PROGNOSIS

AIMS AND OBJECTIVES: To correlate the Diffusion MRI assessed infarct volume with the ASPECT Score to prognosticate clinical outcome in patients of acute stroke. METHOD AND MATERIALS: This was a cross sectional study comprising 36 patients of acute stroke. Diffusion weighted MR was obtained at b values of 0,500 &amp; 1000 on Siemens Magnetom Skyra 3 Tesla scanner. Diffusion restriction on b=1000 image was measured with VOI tool using manual contouring in each slice. Volume was calculated using the formula (Area x slice thickness) after summating the infarct area measured in each slice. ASPECT Score was assessed on CT in each patient at the time of admission of the patient. Correlation of the infarct volume with ASPECTS was done using student t-test with p &lt; 0.05 considered statistically signicant. ROC curve was used to predict cut off of volume of infarct &amp; ASPECTS predicting adverse patient outcome. RESULTS: There was a statistically signicant inverse correlation between the volume of infarct and ASPECTS (p=0.001; r=-0.844). The AUC for a cut-off of 115 cc of the volume of infarct in predicting adverse patient outcome was 0.931 whereas that for ASPECT Scale of 6 was 0.931. CONCLUSION: Infarct volume correlates well with ASPECT Score, both serving as prognostic tools in predicting patient outcome in acute stroke and having comparable efcacy in predicting prognosis. BACKGROUND: Infarct volume and CT ASPECT Score are resourceful parameters in predicting patient prognosis. Limited studies have been done in the Indian population correlating the Volume of infarct and the CT ASPECT Scale.

Abstract 1122‐000171: Unusual Multicompartmental Intracranial Hemorrhage After Tenecteplase Administration

Introduction : The 2019 AHA/ASA updated Guidelines for the Early Management of Patients with Acute Ischemic Stroke mention tenecteplase (TNK) as a reasonable therapy in patients without contraindications for IV fibrinolysis who are also eligible to undergo mechanical thrombectomy. We describe a case of acute left MCA ischemic stroke treated with IV TNK (IV bolus of 0.25 mg/kg) followed by mechanical thrombectomy with subsequent multicompartmental intracranial hemorrhages unrelated to area of infraction. Methods : A retrospective review at a single center university hospital was performed for all intravenous TNK administrations outside of a clinical trial setting from October 2020 to July 2021. Results : A 61‐year‐old male with history of HTN and cardiomyopathy (EF&lt;20%). Presented with sudden onset right sided weakness, aphasia and left gaze. Presenting NIHSS was 28. CT head with hyperdense left MCA sign and ASPECTS score of 10. CTA confirmed proximal left MCA M1 segment occlusion. IV TNK was given within 01:23 hours of symptoms onset. Subsequently, patient underwent emergent mechanical thrombectomy for disabling large vessel occlusion stroke. Spontaneous near complete recanalization of left MCA occlusion was noted on initial angiography run with small non flow limiting distal thrombi visualized in the distal MCA territories. Immediate post procedure CT head was negative for any intracranial hemorrhage. Patient’s exam was noted to improve to NIHSS of 2. Approximately 6 hours after the TNK administration, patient became acutely unresponsive with NIHSS of 26. With Glasgow Coma Scale 7 patient required emergent intubation. CT head revealed bilateral cerebellar intraparenchymal hemorrhages, extensive subarachnoid hemorrhage in basal cisterns and within the sulci in bilateral frontotemporal regions, as well as subdural hemorrhages along the falx and tentorial dural folds. Hypertonic saline was administered followed by emergent extraventricular drain placement. Tranexamic acid 1000 mg was given as emergent reversal, fibrinogen level was 155 mg/dL. Despite aggressive medical management and over following 24 hours, exam worsened with loss of pupillary reflexes. Patient was terminally extubated 2 days after initial presentation in accordance with his advance directives. Conclusions : Tenecteplase was a reasonable choice in this case given LVO and disabling stroke. The patient’s neurological exam improved significantly after TNK with evidence of spontaneous recanalization. However, patient’s multicompartmental intracranial hemorrhages unrelated to area of infraction were unusual in the absence of any vascular lesions to predispose hemorrhage based on CT and conventional angiography. Further observational studies are warranted to evaluate similar complications of Tenecteplase administration and their occurrence rates.