Efficacy and Safety of Colchicine in Pediatric Pericarditis: A Systematic Review and Future Directions.

Pediatric pericarditis presents challenges in its management, necessitating effective therapeutic interventions. Colchicine, known for its efficacy in adults, requires further investigation for its application and safety in pediatric cohorts. A systematic search across renowned databases identified relevant literature on colchicine use in pediatric pericarditis. Twenty-nine articles underwent rigorous screening, with 18 studies meeting inclusion criteria. Data extraction, quality assessment, and synthesis were conducted meticulously. Included studies comprised case reports, case series, and retrospective cohort studies. Colchicine demonstrated efficacy in reducing recurrence rates and symptom burden, with doses ranging from 0.25 mg/day to 2 mg/day. Adverse events were minimal, predominantly gastrointestinal. Notably, nausea was the most common side effect reported. The safety profile of colchicine was favorable, with rare instances of hepatic and hematologic toxicity. Colchicine emerges as a promising therapeutic option for pediatric pericarditis, demonstrating efficacy in reducing recurrence rates and alleviating symptoms. Its favorable safety profile suggests potential as a preferred long-term therapy. However, further research, including randomized controlled trials, is warranted to confirm its efficacy and safety and explore potential combination therapies.

Non-contrast computed tomography features predict intraventricular hemorrhage growth.

OBJECTIVES: Non-contrast computed tomography (NCCT) markers are robust predictors of parenchymal hematoma expansion in intracerebral hemorrhage (ICH). We investigated whether NCCT features can also identify ICH patients at risk of intraventricular hemorrhage (IVH) growth. METHODS: Patients with acute spontaneous ICH admitted at four tertiary centers in Germany and Italy were retrospectively included from January 2017 to June 2020. NCCT markers were rated by two investigators for heterogeneous density, hypodensity, black hole sign, swirl sign, blend sign, fluid level, island sign, satellite sign, and irregular shape. ICH and IVH volumes were semi-manually segmented. IVH growth was defined as IVH expansion > 1 mL (eIVH) or any delayed IVH (dIVH) on follow-up imaging. Predictors of eIVH and dIVH were explored with multivariable logistic regression. Hypothesized moderators and mediators were independently assessed in PROCESS macro models. RESULTS: A total of 731 patients were included, of whom 185 (25.31%) suffered from IVH growth, 130 (17.78%) had eIVH, and 55 (7.52%) had dIVH. Irregular shape was significantly associated with IVH growth (OR 1.68; 95%CI [1.16-2.44]; p = 0.006). In the subgroup analysis stratified by the IVH growth type, hypodensities were significantly associated with eIVH (OR 2.06; 95%CI [1.48-2.64]; p = 0.015), whereas irregular shape (OR 2.72; 95%CI [1.91-3.53]; p = 0.016) in dIVH. The association between NCCT markers and IVH growth was not mediated by parenchymal hematoma expansion. CONCLUSIONS: NCCT features identified ICH patients at a high risk of IVH growth. Our findings suggest the possibility to stratify the risk of IVH growth with baseline NCCT and might inform ongoing and future studies. CLINICAL RELEVANCE STATEMENT: Non-contrast CT features identified ICH patients at a high risk of intraventricular hemorrhage growth with subtype-specific differences. Our findings may assist in the risk stratification of intraventricular hemorrhage growth with baseline CT and might inform ongoing and future clinical studies. KEY POINTS: • NCCT features identified ICH patients at a high risk of IVH growth with subtype-specific differences. • The effect of NCCT features was not moderated by time and location or indirectly mediated by hematoma expansion. • Our findings may assist in the risk stratification of IVH growth with baseline NCCT and might inform ongoing and future studies.

Quantitative Lesion Water Uptake as Stroke Imaging Biomarker: A Tool for Treatment Selection in the Extended Time Window?

BACKGROUND AND PURPOSE: Patients presenting in the extended time window may benefit from mechanical thrombectomy. However, selection for mechanical thrombectomy in this patient group has only been performed using specialized image processing platforms, which are not widely available. We hypothesized that quantitative lesion water uptake calculated in acute stroke computed tomography (CT) may serve as imaging biomarker to estimate ischemic lesion progression and predict clinical outcome in patients undergoing mechanical thrombectomy in the extended time window. METHODS: All patients with ischemic anterior circulation stroke presenting within 4.5 to 24 hours after symptom onset who received initial multimodal CT between August 2014 and March 2020 and underwent mechanical thrombectomy were analyzed. Quantitative lesion net water uptake was calculated from the admission CT. Prediction of clinical outcome was assessed using univariable receiver operating characteristic curve analysis and logistic regression analyses. RESULTS: One hundred two patients met the inclusion criteria. In the multivariable logistic regression analysis, net water uptake (odds ratio, 0.78 [95% CI, 0.64-0.95], P=0.01), age (odds ratio, 0.94 [95% CI, 0.88-0.99]; P=0.02), and National Institutes of Health Stroke Scale (odds ratio, 0.88 [95% CI, 0.79-0.99], P=0.03) were significantly and independently associated with favorable outcome (modified Rankin Scale score ≤1), adjusted for degree of recanalization and Alberta Stroke Program Early CT Score. A multivariable predictive model including the above parameters yielded the highest diagnostic ability in the classification of functional outcome, with an area under the curve of 0.88 (sensitivity 92.3%, specificity 82.9%). CONCLUSIONS: The implementation of quantitative lesion water uptake as imaging biomarker in the diagnosis of patients with ischemic stroke presenting in the extended time window might improve clinical prognosis. Future studies could test this biomarker as complementary or even alternative tool to CT perfusion.

New imaging score for outcome prediction in basilar artery occlusion stroke.

OBJECTIVE: In ischemic posterior circulation stroke, the utilization of standardized image scores is not established in daily clinical practice. We aimed to test a novel imaging score that combines the collateral status with the rating of the posterior circulation Acute Stroke Prognosis Early CT score (pcASPECTS). We hypothesized that this score (pcASCO) predicts functional outcome and malignant cerebellar edema (MCE). METHODS: Ischemic stroke patients with acute BAO who received multimodal-CT and underwent thrombectomy on admission at two comprehensive stroke centers were analyzed. The posterior circulation collateral score by van der Hoeven et al was added to the pcASPECTS to define pcASCO as a 20-point score. Multivariable logistic regression analyses were performed to predict functional independence at day 90, assessed using modified Rankin Scale scores, and occurrence of MCE in follow-up CT using the established Jauss scale score as endpoints. RESULTS: A total of 118 patients were included, of which 84 (71%) underwent successful thrombectomy. Based on receiver operating characteristic curve analysis, pcASCO ≥ 14 classified functional independence with higher discriminative power (AUC: 0.83, 95%CI: 0.71-0.91) than pcASPECTS (AUC: 0.74). In multivariable logistic regression analysis, pcASCO was significantly and independently associated with functional independence (aOR: 1.91, 95%CI: 1.25-2.92, p = 0.003), and MCE (aOR: 0.71, 95%CI: 0.53-0.95, p = 0.02). CONCLUSION: The pcASCO could serve as a simple and feasible imaging tool to assess BAO stroke patients on admission and might be tested as a complementary tool to select patients for thrombectomy in uncertain situations, or to predict clinical outcome. KEY POINTS: • The neurological assessment of basilar artery occlusion stroke patients can be challenging and there are yet no validated imaging scores established in daily clinical practice. • The pcASCO combines the rating of early ischemic changes with the status of the intracranial posterior circulation collaterals. • The pcASCO showed high diagnostic accuracy to predict functional outcome and malignant cerebellar edema and could serve as a simple and feasible imaging tool to support treatment selection in uncertain situations, or to predict clinical outcome.

Impact of relative cerebral blood volume reduction on early neurological improvement in extensive ischemic stroke.

BACKGROUND AND PURPOSE: The benefit of endovascular treatment (EVT) for patients with low Alberta Stroke Program early computed tomography score (ASPECTS) is still ambiguous and is currently being investigated in randomized trials. Computed tomography (CT) perfusion, used to estimate infarct extent and progression, might predict early neurological improvement (ENI) after EVT. We hypothesized that the degree of relative cerebral blood volume (rCBV) reduction is directly associated with ENI in low ASPECTS patients undergoing EVT. METHODS: Ischemic stroke patients with ASPECTS ≤ 5 who received multimodal CT and underwent thrombectomy were analyzed. rCBV reduction was defined as the ratio of cerebral blood volume (CBV), measured in the ischemic lesion to contralateral CBV. Complete reperfusion was defined as an expanded Thrombolysis in Cerebral Infarction score 2c-3. The clinical endpoint was ENI at 24 h, defined continuously (National Institutes of Health Stroke Scale [NIHSS] score change from baseline to 24 h) and binarized (NIHSS score at 24 h ≤ 8). RESULTS: A total of 102 patients were included. Lower rCBV reduction and complete EVT were independently associated with ENI (-11.4 NIHSS points, p = 0.04; -7.3 points, p < 0.0001, respectively). The effect of complete EVT on ENI was directly linked to the degree of rCBV reduction: the probability for binary ENI was +34.6% (p = 0.004) in patients with low rCBV reduction versus +8.2% (p = 0.28) in patients with high rCBV reduction). CONCLUSION: In patients with ischemic stroke with low ASPECTS, ENI was directly linked to the degree of rCBV reduction, a potential indicator of ischemia depth in extensive baseline infarction. Lower rCBV reduction was associated with higher probability of ENI after complete reperfusion, suggesting less pronounced lesion progression despite its large extent and hence, a higher susceptibility to EVT.

Prevalence and patterns of premenstrual disorders and possible association with sexual harassment: a cross-sectional study of young Arab women.

BACKGROUND: Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) represent a range of both psychiatric and physical symptoms that impair quality of life and interfere with daily activities in females. AIMS: To assess the prevalence of PMS and PMDD in Egypt, Jordan and Syria, its demographic associations and the potential link to sexual harassment (SH). METHODS: We used an Arabic version of the premenstrual symptoms screening tool (PSST) to assess the prevalence of PMS and PMDD. Another two-part questionnaire was used to assess the harassment experience. RESULTS: 22,021 women agreed to fill the questionnaire; the majority (65%) aged 18-25 years old. PMS was more prevalent in Egyptian women 77.7% followed by women from Jordan 72.9% then Syria 66.3%. PMDD prevalence followed the same order (40%, 34.7% and 28.2%). Both conditions were significantly associated with obesity and working in medical careers (P = .001). 5733 women agreed to share their sexual harassment experience. Results showed a significant association between the diversity and frequency of sexual harassment and the frequency of the pre-menstrual conditions, PMS Frequency was 87.6%, 80.7% and 78% in participants who were harassed on daily basis Vs. once weekly or monthly vs. few times in their lifetime (p = .04). A similar statistically significant difference was noticed regarding having PMDD (66.4% vs. 47.6% vs. 42.5%). CONCLUSION: The study showed high levels of both PMS and PMDD. The data provided by this study also sheds light on a potential link between SH and developing Pre-menstrual disorders.

Knowledge, attitudes, practices and perceived barriers towards research in undergraduate medical students of six Arab countries.

BACKGROUND: The involvement of the undergraduates in the research field requires a better view of their potential and the anticipated barriers facing them. This study aims to assess the undergraduates' knowledge, attitudes, practices and perceived barriers towards research in six Arab countries. METHODS: A cross sectional study included medical students from six Arab countries, where a self-administered five-section questionnaire was used to assess the students' demographics, knowledge, attitudes, practices and perceived barriers. The questionnaire was distributed in the online educational platforms of the participating medical schools in the six included countries. RESULTS: The total sample of recruited students was 2989, the majority of students (91.6%) showed poor level of knowledge regarding research. Generally high levels of positive attitudes towards research, research relevance and usefulness were found, with moderate levels of perception of research anxiety and difficulty. 33.7% (n = 1006) participated in an actual research project before with a mean of .5 publications per student. Cross-sectional studies were the most common type of studies conducted by students (38.6%), followed by case reports (23.9%). Lack of access to lab equipment for lab research (68.1%), the priority of education over research (66.8%), and lack of time because of educational tasks (66.1%) were generally the top perceived barriers towards research practice. CONCLUSION: In the current study, the participants showed a poor knowledge level with associated positive attitudes towards research. One third of the students participated in research projects that mostly were cross-sectional studies and case reports. Educational tasks and lack of support were the most prevalent barriers. The students' positive attitudes towards research need to be translated into better knowledge and appropriate practice, which can be done by development of better training systems and more structured mentoring.

Brief Review of Chylothorax Diagnosis and Management: Making the Case for Substance Over Appearance.

Chylothorax is the presence of a chylous effusion in the pleural space. Diagnosing chylothorax requires a high clinical suspicion, awareness of the different appearances of a chylothorax and the performance of tests on the pleural fluid, additional to those typically required to differentiate an exudate from a transudate based on Light's criteria. Chylothorax is a more common diagnosis in the trauma and post-surgical patients, but it is still important for practitioners of other disciplines to be aware of it. In this article we provide a concise summary of chylothorax diagnosis and management.

A Review Article on 5-Oxoproline Induced High Anion Gap Metabolic Acidosis.

In 1989, an acquired high anion gap metabolic acidosis due to elevated 5-oxoproline (pyroglutamic acid) was first reported. This is related to chronic acetaminophen use in malnourished patients and women with chronic medical conditions, it could happen even using therapeutic or low doses. The mainstay of treatment is cessation of acetaminophen use along with the administration of intravenous fluids. N-acetyl cysteine might accelerate improvement. The best explanation of the disorder is glutathione depletion and activation of a key enzyme in the γ-glutamyl cycle. This review article aims to highlight the mechanism and management of acquired high anion gap metabolic acidosis caused by 5-oxoproline in the adult population.

Surface Structuring Combined with Chemical Surface Functionalization: An Effective Tool to Manipulate Cell Adhesion.

In this study, we investigate how a surface structure underneath a surface-attached polymer coating affects the bioactivity of the resulting material. To that end, structured surfaces were fabricated using colloidal lithography (lateral dimensions: 200 nm to 1 µm, height ~15 to 50 nm). The surface structures were further functionalized either with antimicrobial, cell-adhesive polycations or with protein-repellent polyzwitterions. The materials thus obtained were compared to non-functionalized structured surfaces and unstructured polymer monolayers. Their physical properties were studied by contact-angle measurements and atomic force microscopy (AFM). Protein adhesion was studied by surface plasmon resonance spectroscopy, and the antimicrobial activity against Escherichia coli bacteria was tested. The growth of human mucosal gingiva keratinocytes on the materials was analyzed using the Alamar blue assay, optical microscopy, and live-dead staining. The data shows that the underlying surface structure itself reduced protein adhesion and also bacterial adhesion, as evidenced by increased antimicrobial activity. It also enhanced cell adhesion to the surfaces. Particularly in combination with the adhesive polycations, the surfaces increased the cell growth compared to the unstructured reference materials. Thus, functionalizing structured surfaces with adhesive polymer could be a valuable tool for improved tissue integration.

Bifunctional Bioactive Polymer Surfaces with Micrometer and Submicrometer-sized Structure: The Effects of Structure Spacing and Elastic Modulus on Bioactivity.

This study presents a comparison of two types of bifunctional structured surface that were made from the same polymer -- an antimicrobial polycation (a synthetic mimic of an antimicrobial peptide, SMAMP) and a protein-repellent polyzwitterion (poly(sulfobetaines), PSB). The first type of bifunctional surface was fabricated by a colloidal lithography (CL) based process where the two polymers were immobilized sequentially onto pre-structured surfaces with a chemical contrast (gold on silicon). This enabled site-selective covalent attachment. The CL materials had a spacing ranging from 200 nm to 2 µm. The second type of structured surface (spacing: 1 - 8.5 µm) was fabricated using a microcontact printing (µCP) process where SMAMP patches were printed onto a PSB network, so that 3D surface features were obtained. The thus obtained materials were studied by quantitative nanomechanical measurements using atomic force microscopy (QNM-AFM). The different architectures led to different local elastic moduli at the polymer-air interface, where the CL surfaces were much stiffer (Derjaguin-Muller-Toporov (DMT) modulus = 20 ± 0.8 GPa) compared to the structured 3D networks obtained by µCP (DMT modulus = 42 ± 1.1 MPa). The effects of the surface topology and stiffness on the antimicrobial activity against Escherichia coli, the protein repellency (using fibrinogen), and the compatibility with human gingival mucosal keratinocytes were investigated. The softer 3D µCP surfaces had simultaneous antimicrobial activity, protein repellency, and cell compatibility at all spacings. For the stiffer CL surfaces, quantitative simultaneous antimicrobial activity and protein repellency was not obtained. However, the cell compatibility could be maintained at all spacings. The optimum spacing for the CL materials was in the range of 500 nm-1 µm, with significantly reduced antimicrobial activity at 2 µm spacing. Thus, the soft polymer network obtained by µCP could be more easily optimized than the stiff CL surface, and had a broader topology range of optimal or near-optimal bioactivity.

Extensive Bilateral Nodular Lung: A Diagnostic Challenge.

An elderly female presented to the emergency department with a two-month history of dyspnea on exertion and productive cough. Imaging revealed miliary nodular pattern involving both lungs. She underwent extensive work up evaluating different possible pathological processes. The condition was ultimately lethal. In this educational case report, we review the common - and not-so-common - etiologies that might present with this constellation of signs and symptoms, along with the diagnostic strategies and thought processes used to identify the final diagnosis.

Knowledge, Attitude and Perceptions of Healthcare Workers in Arab Countries Regarding Basic Life Support; a Systematic Review and Meta-Analysis.

Introduction: Effective Basic Life Support (BLS) interventions, including cardiopulmonary resuscitation (CPR), are essential for enhancing survival rates. This review aimed to evaluate the knowledge, attitudes, and perceptions (KAP) of healthcare professionals regarding BLS in Arab countries. Methods: We conducted a systematic search on PubMed, Cochrane, Scopus, Web of Science, and EMBASE, to identify relevant studies. We included studies performed in Arab countries that included healthcare workers' KAP assessment towards BLS. The meta-analysis was carried out utilizing the OpenMeta Analyst Software, and a subgroup analysis was performed for Nursing staff category. The quality of the included cross-sectional studies was assessed through Newcastle-Ottawa quality assessment scale. Results: A total of 18 studies were included in our study, and eight of them entered the analysis. The study showed that 61.3% (95% confidence interval (CI): 48.9%, 73.7%, p<0.001) of health care workers were knowledgeable about the correct CPR ratio, and 62.1% (95% CI: 51.7%, 72.5%, p<0.001) answered the location of chest compression correctly. While, only 36.5% (95% CI: 23.5%, 49.6%, p<0.001) had correct answers regarding the compression rate, 48.1% (95% CI: 38.1%, 58.0%, p<0.001) were aware of the compression depth, and 34.8% (95% CI: 22.9%, 46.7%, p<0.001) answered the sequence correctly. Conclusion: The study revealed a gap regarding the BLS KAP of healthcare workers in different Arab countries, which crucially requires taking actions, in terms of frequent certified training sessions, assessments, and clear protocols.

Mobile Stroke Units in Acute Ischemic Stroke: A Comprehensive Systematic Review and Meta-Analysis of 5 "T Letter" Domains.

Intravenous thrombolysis (IVT) may be administered to stroke patients requiring immediate treatment more quickly than emergency medical services if certain conditions are met. These conditions include the presence of mobile stroke units (MSUs) with on-site treatment teams and a computed tomography scanner. We compared clinical outcomes of MSU conventional therapy by emergency medical services through a systematic review and meta-analysis. We searched key electronic databases from inception till September 2021. The primary outcomes were mortality at 7 and 90 days. The secondary outcomes included the modified Rankin Scale score at 90 days, alarm to IVT or intra-arterial recanalization, and time from symptom onset or last known well to thrombolysis. We included 19 controlled trials and cohort studies to conduct our final analysis. Our comparison revealed that 90-day mortality significantly decreased in the MSU group compared with the conventional care group [risk ratio = 0.82; 95% confidence interval (CI), 0.71-0.95], while there was no significant difference at 7 days (risk ratio = 0.89; 95% CI, 0.69-1.15). MSU achieved greater functional independence (modified Rankin Scale = 0-2) at 90 days (risk ratio = 1.08; 95% CI, 1.01-1.16). MSU was associated with shorter alarm to IVT or intra-arterial recanalization time (mean difference = -29.69; 95% CI, -34.46 to -24.92), treating patients in an earlier time window, as shown through symptom onset or last known well to thrombolysis (mean difference = -36.79; 95% CI, -47.48 to -26.10). MSU-treated patients had a lower rate of 90-day mortality and better 90-day functional outcomes by earlier initiation of IVT compared with conventional care.

How much of the variance in functional outcome related to intracerebral hemorrhage volume is already apparent in neurological status at admission?

BACKGROUND: Hematoma volume is a major pathophysiological hallmark of acute intracerebral hemorrhage (ICH). We investigated how the variance in functional outcome induced by the ICH volume is explained by neurological deficits at admission using a mediation model. METHODS: Patients with acute ICH treated in three tertiary stroke centers between January 2010 and April 2019 were retrospectively analyzed. Mediation analysis was performed to investigate the effect of ICH volume (0.8 ml (5% quantile) versus 130.6 ml (95% quantile)) on the risk of unfavorable functional outcome at discharge defined as modified Rankin Score (mRS) ≥ 3 with mediation through National Institutes of Health Stroke Scale (NIHSS) at admission. Multivariable regression was conducted to identify factors related to neurological improvement and deterioration. RESULTS: Three hundred thirty-eight patients were analyzed. One hundred twenty-one patients (36%) achieved mRS ≤ 3 at discharge. Mediation analysis showed that NIHSS on admission explained 30% [13%; 58%] of the ICH volume-induced variance in functional outcome at smaller ICH volume levels, and 14% [4%; 46%] at larger ICH volume levels. Higher ICH volume at admission and brainstem or intraventricular location of ICH were associated with neurological deterioration, while younger age, normotension, lower ICH volumes, and lobar location of ICH were predictors for neurological improvement. CONCLUSION: NIHSS at admission reflects 14% of the functional outcome at discharge for larger hematoma volumes and 30% for smaller hematoma volumes. These results underscore the importance of effects not reflected in NIHSS admission for the outcome of ICH patients such as secondary brain injury and early rehabilitation.

Synthesis of innovative and sustainable gelatin@graphene oxide-crosslinked-zirconium silicate@gelatin nanobiosorbent for effective biosorption of basic fuchsin dye.

Most dye stuffs and coloring materials are mainly categorized as hazardous pollutants in water effluents due to their nature as non-biodegradable, highly toxic and extremely carcinogenic. For this reason, rapid and efficient eradication of waste dyes from wastewaters before discharging into water streams must be accomplished by an acceptable approach as adsorption technique. Therefore, the present study is aimed and devoted to synthesize a novel nanobiosorbent from three different constituents, gelatin (Gel) as a sustainable natural product, graphene oxide (GO) as an example of highly stable carbonaceous material and zirconium silicate (ZrSiO4) as an example of combined metal oxides for the formation of Gel@GO-F-ZrSiO4@Gel by using formaldehyde (F) as a cross-linkage reagent. Several characterization techniques as FT-IR were employed to identify the incorporated surface reactive Functionalities in Gel@GO-F-ZrSiO4@Gel as -OH, =NH, -NH2, -COOH and C=O, etc. The morphology for particle shape and size of Gel@GO-F-ZrSiO4@Gel were confirmed from the SEM and TEM analyses providing 15.75- 32.79 nm. The surface area was determined by the BET and found to correspond to 219.46 m2 g-1. Biosorptive removal of basic fuchsin (BF) pollutant as an example of a widely applicable dye in various activities was monitored and optimized under the influence of pH (2-10), reaction time (1-30 min), initial BF pollutant concentration (5-100 mg L-1), nanobiosorbent dosage (5-60 mg), temperature (30-60 °C) and interfering ions. The maximum biosorptive removal values of BF dye were established as 96.0 and 95.2% using 5 and 10 mg L-1, respectively at the recommended pH 7 condition. The Thermodynamic parameters demonstrated that the BF dye adsorption onto Gel@GO-F-ZrSiO4@Gel was taken place via spontaneous and endothermic reaction. Chemisorption is the predominant adsorption mechanism by forming multilayers upon nonhomogeneous surface in accordance with Freundlich model hypothesis. The applicability of the optimized Gel@GO-F-ZrSiO4@Gel in biosorptive removal of BF pollutant from real water sample was successfully accomplished by the batch technique. Thus, this study clearly shows that Gel@GO-F-ZrSiO4@Gel exhibited significant influences on remediation of industrial effluents containing BF pollutant with superior efficiency.

Assessment of Irreversible Tissue Injury in Extensive Ischemic Stroke-Potential of Quantitative Cerebral Perfusion.

Computed tomography perfusion (CTP) is used as a tool to select ischemic stroke patients for endovascular treatment (EVT) and is currently investigated in the setting of extensive stroke with low Alberta Stroke Program Early CT scores (ASPECTS). The purpose of this study was to perform a comprehensive quantitative analysis of cerebral blood flow within the ischemic lesion compared to threshold-derived core lesion volumes. We hypothesized that the degree of cerebral blood volume (CBV) reduction within the ischemic lesion is predictive of irreversible tissue injury and functional outcome in patients with low ASPECTS. Ischemic stroke patients with an ASPECTS ≤ 5 who received multimodal CT on admission and underwent thrombectomy were analyzed. The ischemic lesion on CTP was identified, and CTP-derived parameters were measured as absolute means within the lesion and relative to the physiological perfusion measured in a contralateral region of interest. The degree of irreversible tissue injury was assessed using quantitative net water uptake (NWU). Functional endpoint was good outcome defined as modified Rankin Scale (mRS) scores 0-3 at day 90. One hundred eleven patients were included. The median core lesion volume was 71 ml (IQR: 25-107), and the median quantitative NWU was 9.5% (IQR: 6-13). Relative CBV (rCBV) reduction and ASPECTS at baseline were independently associated with NWU in multivariable linear regression analysis (ß: 12.4, 95%CI: 6.0-18.9, p < 0.0001) and (ß: - 0.78, 95% CI: - 1.53 to - 0.02; p = 0.045), respectively. Furthermore, rCBV was significantly associated with good outcome in patients with core volumes > 50 ml (OR: 0.16, 95% CI: 0.05-0.49, p = 0.001). Our study shows that rCBV reduction serves as an early surrogate for increase of NWU as a marker of irreversible tissue injury and lesion progression. Thus, the analysis of rCBV reduction within ischemic lesions may add another dimension to acute stroke triage in addition to core volumes or ASPECTS as indicators of the infarct extent and viability.

Safety and efficacy of total ankle arthroplasty versus ankle arthrodesis for ankle osteoarthritis: A systematic review and meta-analysis.

Osteoarthritis is the most common joint disease-causing pain and disability, and its management keeps creating a debate. So, we aimed to compare the safety and efficacy of total ankle arthroplasty and ankle arthrodesis for ankle osteoarthritis. We searched PubMed, Cochrane, Scopus, and Web of Science till August 2021. The outcomes were pooled as Mean difference (MD) or Risk Ratio (RR), and 95% confidence interval. We included 36 studies. The results showed a significantly lower risk of infections in total ankle arthroplasty (TAA) than ankle arthrodesis (AA) (RR= 0.63, 95% CI [0.57, 0.70], p < 0.00001), amputations (RR= 0.40, 95% CI [0.22, 0.72], p = 0.002), postoperative non-union (RR= 0.11, 95% CI [0.03, 0.34], p = 0.0002), and a significant increase of overall range of motion in TAA than AA. Our results preferred total ankle arthroplasty over ankle arthrodesis in terms of lowering the rates of infections, amputations, and postoperative non-union, with better change in the overall range of motion.