Predictors of Successful First-Pass Thrombectomy with a Balloon Guide Catheter: Results of a Decision Tree Analysis.

Complete recanalization after a single retrieval maneuver is an interventional goal in acute ischemic stroke and an independent factor for good clinical outcome. Anatomical biomarkers for predicting clot removal difficulties have not been comprehensively analyzed and await unused. We retrospectively evaluated 200 consecutive patients who suffered acute stroke and occlusion of the anterior circulation and were treated with mechanical thrombectomy through a balloon guide catheter (BGC). The primary objective was to evaluate the influence of carotid tortuosity and BGC positioning on the one-pass Modified Thrombolysis in Cerebral Infarction Scale (mTICI) 3 rate, and secondarily, the influence of communicating arteries on the angiographic results. After the first-pass mTICI 3, recanalization fell from 51 to 13%. The regression models and decision tree (supervised machine learning) results concurred: carotid tortuosity was the main constraint on efficacy, reducing the likelihood of mTICI 3 after one pass to 30%. BGC positioning was relevant only in carotid arteries without elongation: BGCs located in the distal internal carotid artery (ICA) had a 70% probability of complete recanalization after one pass, dropping to 43% if located in the proximal ICA. These findings demonstrate that first-pass mTICI 3 is influenced by anatomical and interventional factors capable of being anticipated, enabling the BGC technique to be adapted to patient's anatomy to enhance effectivity.

In vivo assessment of number of milk duct orifices in lactating women and association with parameters in the mother and the infant.

BACKGROUND: In vitro and in vivo analyses differ between the number of milk ducts found in the lactating breast, and there is a lack of knowledge as to whether or not external factors in the mother or the child affect the number of ductal orifices. The aim of this study was to determine the number of milk duct orifices in vivo and to investigate the possible influence of variable parameters in mother and infant. STUDY DESIGN: Prospective clinical trial. In 98 breastfeeding women we investigated the nipple surface in order to identify the number of milk duct orifices using Marmet's manual milk expression technique. In addition mothers were interviewed on different parameters of birth and breastfeeding. RESULTS: Every nipple had 3.90 ± 1.48 milk duct orifices on average. There was no significant difference between left and right breasts. The use of a breast pump in addition to breastfeeding did not have any effect on the number of ductal orifices. Multiparous women exhibited more ductal orifices (8.5 ± 3.0) as compared to primipara (7.1 ± 2.7). Boys were associated with significantly more ductal orifices in their mother's right breast (4.2 ± 1.7) than girls (3.5 ± 1.4). Furthermore boys were breastfed for longer per session. A shorter birth height of males correlated with more ductal orifices in left nipples. Fluid intake of mothers was associated with a higher number of ductal orifices. Restless infant behavior could not be explained by less milk duct orifices. Pain in the breast during breastfeeding did not have an influence on ductal orifices either. Psychological criteria, such as duration of maternity leave and total intended breastfeeding period, did not affect the number of orifices in the papilla mammaria of breasts during lactation. CONCLUSION: For the first time an in vivo investigation of the number of ductal orifices in lactating women was conducted non-invasively and associations with variables in the mother and the child, birth parameters in infants, and breastfeeding parameters in mothers and children were assessed. We conclude that the number of activated ductal orifices on the surface of the nipple is primarily associated with functional aspects.

Comparison of 3 bonded lingual appliances by auditive analysis and subjective assessment.

The aim of this prospective study was to compare for the first time the influences of lingual appliances of different dimensions on sound performance and oral comfort. The study group comprised 12 subjects (10 women, 2 men; mean age, 33.96 years). Their sound production was recorded by means of a digital audio tape recorder before, 10 minutes after, and 24 hours after placement of the different appliances for semiobjective assessment by 3 blinded speech professionals. This was followed by supplementary subjective ratings of sound performance and oral comfort by the patients. All lingual appliances induced significant impairment in sound performance and oral comfort. However, they varied significantly with respect to the degree of impairment. The smaller the appliance, the less pronounced the impairments it induced. The smallest changes were induced by a bonded canine-to-canine retainer, followed by customized lingual brackets and prefabricated lingual brackets. By using lower-profile customized brackets, the orthodontist can significantly enhance patient comfort and significantly reduce impairments of sound performance in comparison with prefabricated brackets with larger dimensions. Before placing a lingual appliance, however, patients should be briefed on possible effects such as impaired sound production and decreased oral comfort.