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Purpose: Endovascular treatment (ET) in patients with large vessel occlusion stroke (LVOS) with unknown onset or an extended time window can be safe and effective if patients are selected by defined clinical and imaging criteria; however, it is unclear if these criteria should also be applied to patients with unknown onset and unknown time last known well. In this study, we aimed to assess whether absent information on the time patients were last known to be well impacts outcome in patients with unknown onset LVOS.
Methods: We analyzed patients who were enrolled in the German Stroke Registry-Endovascular Treatment between 2015 and 2019. Patients with unknown onset and unknown time last known well (LKWu) were compared to patients with known onset (KO) and to patients with unknown onset but known time last known well (LKWk) regarding clinical and imaging baseline characteristics and outcome.
Results: Out of 5909 patients, 561 presented with LKWu (9.5%), 1849 with LKWk (31.3%) and 3499 with KO (59.2%). At 90 days, functional independency was less frequent in LKWu (27.0%) compared to KO (42.6%) and LKWk patients (31.8%). These differences were not significant after adjusting for confounders. A main confounder was the initial Alberta stroke program early CT score.
Conclusion: The LKWu patients had a similar outcome after ET as KO and LKWk patients after adjusting for confounders. Thus, ET should not be withheld if the time last known well is unknown. Instead, LKWu patients may be selected for ET using the same criteria as in LKWk patients.
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http://dx.doi.org/10.1007/s00062-022-01188-5 | DOI Listing |
Intern Med J
December 2024
Internal Medicine Services, The Prince Charles Hospital, Brisbane, Queensland, Australia.
Background: Iron deficiency anaemia (IDA) related to occult gastrointestinal tract (GIT) blood loss is associated with high rates of GIT malignancies. Major society guidelines recommend bidirectional endoscopic evaluation for all men and post-menopausal women with newly diagnosed, unexplained IDA. However, in patients prescribed direct oral anticoagulants (DOACs), the endoscopic yield, specifically the rate of high-risk findings, including colorectal cancers (CRCs) and advanced adenomas (AAs), is unknown.
View Article and Find Full Text PDFLancet Reg Health Eur
January 2025
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands.
Background: Physiological-based cord clamping (PBCC) in preterm infants is beneficial for cardiovascular transition at birth and may optimize placental transfusion. Whether PBCC can improve clinical outcomes is unknown. The aim of the Aeration, Breathing, Clamping (ABC3) trial was to test whether PBCC results in improved intact survival in very preterm infants.
View Article and Find Full Text PDFAcc Chem Res
December 2024
Department of Chemical and Petroleum Engineering, University of Kansas, Lawrence, Kansas 66045, United States.
ConspectusThe surface of a catalyst is crucial for understanding the mechanisms of catalytic reactions at the molecular level and developing new catalysts with higher activity, selectivity, and durability. Ambient pressure X-ray photoelectron spectroscopy (AP-XPS) is a technique studying the surface of a sample in the gas phase, mainly identifying chemical identity, analyzing oxidation state, and measuring surface composition.In the last decade, numerous photoelectron spectroscopic methods for fundamental studies of key topics in catalysis using AP-XPS have been developed.
View Article and Find Full Text PDFWorld J Exp Med
December 2024
Department of Internal Medicine, Gayatri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam 530048, Andhra Pradesh, India.
Obesity is increasingly prevalent worldwide, with genetic factors contributing to its development. The hypothalamic leptin-melanocortin pathway is central to the regulation of appetite and weight; leptin activates the proopiomelanocortin neurons, leading to the production of melanocortin peptides; these in turn act on melanocortin 4 receptors (MC4R) which suppress appetite and increase energy expenditure. MC4R mutations are responsible for syndromic and non-syndromic obesity.
View Article and Find Full Text PDFGait initiation is a fundamental human task, requiring one or more anticipatory postural adjustments (APA) prior to stepping. Deviations in amplitude and timing of APAs exist in Parkinson's disease (PD), causing dysfunctional postural control which increases the risk of falls. The motor cortex and basal ganglia have been implicated in the regulation of postural control, however, their dynamics during gait initiation, relationship to APA metrics, and response to pharmacotherapy such as levodopa are unknown.
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