Statistical analysis plan for the multicenter, open, randomized controlled clinical trial to assess the efficacy and safety of intravenous tirofiban vs aspirin in acute ischemic stroke due to tandem lesion, undergoing recanalization therapy by endovascular treatment (ATILA trial).

RATIONALE: In-stent reocclusion after endovascular therapy has a negative impact on outcomes in acute ischemic stroke (AIS) due to tandem lesions (TL). Optimal antiplatelet therapy approach in these patients to avoid in-stent reocclusion is yet to be elucidated. AIMS: To assess efficacy and safety of intravenous tirofiban versus intravenous aspirin in patients undergoing MT plus carotid stenting in the setting of AIS due to TL. SAMPLE SIZE ESTIMATES: Two hundred forty patients will be enrolled, 120 in every treatment arm. METHODS AND DESIGN: A multicenter, prospective, randomized, controlled (aspirin group), assessor-blinded clinical trial will be conducted. Patients fulfilling the inclusion criteria will be randomized at MT onset to the experimental or control group (1:1). Intravenous aspirin will be administered at a 500-mg single dose and tirofiban at a 500-mcg bolus followed by a 200-mcg/h infusion during the first 24 h. All patients will be followed for up to 3 months. STUDY OUTCOMES: Primary efficacy outcome will be the proportion of patients with carotid in-stent thrombosis within the first 24 h after MT. Primary safety outcome will be the rate of symptomatic intracranial hemorrhage. DISCUSSION: This will be the first clinical trial to assess the best antiplatelet therapy to avoid in-stent thrombosis after MT in patients with TL. TRIAL REGISTRATION: The trial is registered as NCT05225961. February, 7th, 2022.

Reduction of sugar, salt and fat content in foods over the period 2016-2021 in Spain: the National Food Reformulation Plan.

BACKGROUND/OBJECTIVES: Population´s dietary intake of saturated fat, sodium, and sugars is higher than the current recommendations in Spain and most European countries. Nationwide food reformulation strategies have the potential to improve nutritional quality; however, evaluations are only available in a few countries and are difficult to compare. This study shows the degree of compliance with the nutrient reduction objectives included in a 4-year (2016-2020) Spanish food reformulation initiative. METHODS: In 2016, baseline median nutrient content was established for 57 food subcategories. Agreed reduction (%) expressed as the median content to be reached by 2020 was set as the objective. In 2021, Spanish Food Safety and Nutrition Agency (AESAN) collected mandatory nutritional information from 3118 products belonging to the food subcategories included in the PLAN. Median nutrient content was calculated and compared with baseline data established in 2016 and PLAN objectives. RESULTS: Median nutrient content reduction was observed in all food subcategories. Relative reductions (%) ranged from 0.6 to 60% for added sugars, 4.8 to 33.3% for salt, 4.5 to 78.3% for saturated fat, and 24.9 to 36% for total fat. PLAN objectives were achieved in all subcategories except for one. The number of products involved, belonging to the highly consumed food categories, shows the potential of national reformulation strategies to improve the nutritional quality of the diet. CONCLUSION: Compliance with nutrient reduction agreements was 99%; however, the variability of nutrient content within subcategories shows that there is room for further reduction in selected nutrients and food subcategories.

A nation-wide analysis of socioeconomic and geographical disparities in the prevalence of obesity and excess weight in children and adolescents in Spain: Results from the ENE-COVID study.

OBJECTIVE: To estimate national and provincial prevalence of obesity and excess weight in the child and adolescent population in Spain by sex and sociodemographic characteristics, and to explore sources of inequalities in their distribution, and their geographical patterns. METHODS: ENE-COVID is a nationwide representative seroepidemiological survey (68 287 participants) stratified by province and municipality size (April-June 2020). Participants answered a questionnaire which collected self-reported weight and height, that allowed estimating crude and model-based standardized prevalences of obesity and excess weight in the 10 543 child and adolescent participants aged 2-17 years. RESULTS: Crude prevalences (WHO growth reference) were higher in boys than in girls (obesity: 13.4% vs. 7.9%; excess weight: 33.7% vs. 26.0%; severe obesity: 2.9% vs. 1.2%). These prevalences varied with age, increased with the presence of any adult with excess weight in the household, while they decreased with higher adult educational and census tract average income levels. Obesity by province ranged 1.8%-30.5% in boys and 0%-17.6% in girls; excess weight ranged 15.2%-49.9% in boys and 10.8%-40.8% in girls. The lowest prevalences of obesity and excess weight were found in provinces in the northern half of Spain. Sociodemographic characteristics only partially explained the observed geographical variability (33.6% obesity; 44.2% excess weight). CONCLUSIONS: Childhood and adolescent obesity and excess weight are highly prevalent in Spain, with relevant sex, sociodemographic and geographical differences. The geographic variability explained by sociodemographic variables indicates that there are other potentially modifiable factors on which to focus interventions at different geographic levels to fight this problem.

Impact of Balloon Guide Catheters in Elderly Patients Treated with Mechanical Thrombectomy: Insights from the ROSSETTI Registry.

BACKGROUND AND PURPOSE: Several nonrandomized studies have demonstrated the effectiveness of balloon guide catheters in treating patients with anterior circulation large-vessel occlusion. However, their impact on the elderly populations has been underreported. We aimed to analyze the effect of balloon guide catheters in a cohort of elderly patients (80 years of age or older) with anterior circulation large-vessel occlusion. MATERIALS AND METHODS: Consecutive patients from June 2019 to June 2022 were collected from the ROSSETTI Registry. Demographic and clinical data, angiographic endovascular technique, and clinical outcome were compared between balloon guide catheter and non-balloon guide catheter groups. We studied the association between balloon guide catheters and the rate of complete recanalization after a single first-pass effect modified TICI 2c-3, as well as their association with functional independence at 3 months. RESULTS: A total of 808 patients were included during this period, 465 (57.5%) of whom were treated with balloon guide catheters. Patients treated with balloon guide catheters were older, had more neurologic severity at admission and lower baseline ASPECTS, and were less likely to receive IV fibrinolytics. No differences were observed in terms of the modified first-pass effect between groups (45.8 versus 39.9%, P = .096). In the multivariable regression analysis, balloon guide catheter use was not independently associated with a modified first-pass effect or the final modified TICI 2c-3, or with functional independence at 3 months. CONCLUSIONS: In our study, balloon guide catheter use during endovascular treatment of anterior circulation large-vessel occlusion in elderly patients did not predict the first-pass effect, near-complete final recanalization, or functional independence at 3 months. Further studies, including randomized clinical trials, are needed to confirm these results.

Socio-geographical disparities of obesity and excess weight in adults in Spain: insights from the ENE-COVID study.

Background: In Spain, differences in the prevalence of obesity and excess weight according to sex and sociodemographic factors have been described at the national level, although current data do not allow to delve into geographical differences for these conditions. The aim was to estimate national and regional prevalences of adult obesity and excess weight in Spain by sex and sociodemographic characteristics, and to explore difference sources of inequalities in its distribution, as well as its geographical pattern. Method: ENE-COVID study was a nationwide representative seroepidemiological survey with 57,131 participants. Residents in 35,893 households were selected from municipal rolls using a two-stage random sampling stratified by province and municipality size (April-June 2020). Participants (77.0% of contacted individuals) answered a questionnaire which collected self-reported weight and height, as well as different socioeconomic variables, that allowed estimating crude and standardized prevalences of adult obesity and excess weight. Results: Crude prevalences of obesity and excess weight were higher in men (obesity: 19.3% vs. 18.0%; excess weight: 63.7% vs. 48.4%), while severe obesity was more prevalent in women (4.5% vs. 5.3%). These prevalences increased with age and disability, and decreased with education, census tract income and municipality size. Differences by educational level, relative census income, nationality or disability were clearly higher among women. Obesity by province ranged 13.3-27.4% in men and 11.4-28.1% in women; excess weight ranged 57.2-76.0% in men and 38.9-59.5% in women. The highest prevalences were located in the southern half of the country and some north-western provinces. Sociodemographic characteristics only explained a small part of the observed geographical variability (25.2% obesity). Conclusion: Obesity and overweight have a high prevalence in Spain, with notable geographical and sex differences. Socioeconomic inequalities are stronger among women. The observed geographical variability suggests the need to implement regional and local interventions to effectively address this public health problem.

[Qualitative study on food perceptions, dietary practices and healthy lifestyles in the adolescent population.] / Estudio cualitativo sobre las percepciones en alimentación, prácticas alimentarias y hábitos de vida saludables en población adolescente.

OBJECTIVE: Child and adolescent obesity is a biggest public health challenge. Adolescence is a critical stage for growth and development. The objective of the research was to explore and understand the perceptions of the adolescent population about eating and healthy lifestyle habits, and the identification of barriers and facilitators. METHODS: A multicenter qualitative research was made, in schoolchildren from twelve to fourteen years old, from four Secondary Schools, distributed in four municipalities. During the first quarter of the 2021-2022 school year, ten Discussion Groups were conducted, with 7-11 participants per group, and two ninety-minute work sessions per group. The proceedings were followed by two deliberative sessions. The Atlas.ti version 8 software was used for data content analysis, following the methodological recommendations of Mayring and Cáceres, and the open coding technique was used. RESULTS: A relationship was observed between the foods most consumed in the family home and the ones that teenagers liked most. Also the extracurricular sports activity was highlighted as the main source of physical activity as well as the connection between mental health and healthy practices, and the emphasis about the variety of foods, the importance given to sustainability and the relationship of an unhealthy diet with excess intake of sugar, sweets, soft drinks, fast food and fats. The family was revealed as one of the most influential factors, followed by professionals, the media and high schools. Among the perceived barriers were the socioeconomic level, lack of time, food supply in canteens and social pressure. CONCLUSIONS: The main barriers and motivations linked to the food environment, socioeconomic level, body image and emotional well-being are identified. Adolescents express interest in participating in public policies.

OBJETIVO: La obesidad infanto-juvenil supone un verdadero reto de Salud Pública. La adolescencia es una etapa crítica para el crecimiento y el desarrollo. El objetivo del estudio fue explorar y comprender las percepciones de la población adolescente sobre alimentación y hábitos de vida saludables, así como la identificación de barreras y elementos facilitadores. METODOS: Se realizó un estudio cualitativo multicéntrico, en escolares de doce a catorce años, de cuatro Institutos de Educación Secundaria, distribuidos en cuatro municipios. Durante el primer trimestre del curso escolar 2021-2022 se realizaron diez grupos de discusión, con siete-once participantes por grupo, y dos sesiones de trabajo de noventa minutos de duración, por grupo. Fueron seguidos de dos sesiones deliberativas. Para el análisis del contenido de los datos se utilizó el software Atlas.ti versión 8, siguiendo las recomendaciones metodológicas de Mayring y Cáceres, y se empleó la técnica de codificación abierta. RESULTADOS: Se observó una relación entre los alimentos más consumidos en la vivienda familiar y los que más les gustaban, destacó la actividad extracurricular deportiva como la principal fuente de actividad física y la conexión entre la salud mental y las prácticas saludables, así como el énfasis que pusieron en la variedad de alimentos, la importancia concedida a la sostenibilidad y la relación de una alimentación no saludable con el exceso de azúcar, chucherías, refrescos, comida rápida y grasas. La familia se presentó como uno de los factores más influyentes, seguido de los profesionales, los medios de comunicación y el instituto. Entre las barreras percibidas destacaron: nivel socioeconómico, falta de tiempo, oferta de la cafetería del instituto y presión social. CONCLUSIONES: Se identifican las principales barreras y elementos facilitadores vinculados al entorno alimentario, nivel socioeconómico, imagen corporal y bienestar emocional. Los adolescentes expresan interés en participar en políticas públicas.

Estudio cualitativo sobre las percepciones en alimentación, prácticas alimentarias y hábitos de vida saludables en población adolescente / Qualitative study on food perceptions, dietary practices and healthy lifestyles in the adolescent population

Fundamentos: La obesidad infanto-juvenil supone un verdadero reto de Salud Pública. La adolescencia es una etapa crítica parael crecimiento y el desarrollo. El objetivo del estudio fue explorar y comprender las percepciones de la población adolescente sobrealimentación y hábitos de vida saludables, así como la identificación de barreras y elementos facilitadores.Métodos: Se realizó un estudio cualitativo multicéntrico, en escolares de doce a catorce años, de cuatro Institutos de EducaciónSecundaria, distribuidos en cuatro municipios. Durante el primer trimestre del curso escolar 2021-2022 se realizaron diez grupos dediscusión, con siete-once participantes por grupo, y dos sesiones de trabajo de noventa minutos de duración, por grupo. Fueronseguidos de dos sesiones deliberativas. Para el análisis del contenido de los datos se utilizó el software Atlas.ti versión 8, siguiendolas recomendaciones metodológicas de Mayring y Cáceres, y se empleó la técnica de codificación abierta.Resultados: Se observó una relación entre los alimentos más consumidos en la vivienda familiar y los que más les gustaban,destacó la actividad extracurricular deportiva como la principal fuente de actividad física y la conexión entre la salud mental y lasprácticas saludables, así como el énfasis que pusieron en la variedad de alimentos, la importancia concedida a la sostenibilidad yla relación de una alimentación no saludable con el exceso de azúcar, chucherías, refrescos, comida rápida y grasas. La familia sepresentó como uno de los factores más influyentes, seguido de los profesionales, los medios de comunicación y el instituto. Entre lasbarreras percibidas destacaron: nivel socioeconómico, falta de tiempo, oferta de la cafetería del instituto y presión social.Conclusiones: Se identifican las principales barreras y elementos facilitadores vinculados al entorno alimentario...(AU)

Background: Child and adolescent obesity is a biggest public health challenge. Adolescence is a critical stage for growth anddevelopment. The objective of the research was to explore and understand the perceptions of the adolescent population about eatingand healthy lifestyle habits, and the identification of barriers and facilitators.Methods: A multicenter qualitative research was made, in schoolchildren from twelve to fourteen years old, from four SecondarySchools, distributed in four municipalities. During the first quarter of the 2021-2022 school year, ten Discussion Groups were conducted,with 7-11 participants per group, and two ninety-minute work sessions per group. The proceedings were followed by two deliberativesessions. The Atlas.ti version 8 software was used for data content analysis, following the methodological recommendations of Mayringand Cáceres, and the open coding technique was used.Results: A relationship was observed between the foods most consumed in the family home and the ones that teenagersliked most. Also the extracurricular sports activity was highlighted as the main source of physical activity as well as the connectionbetween mental health and healthy practices, and the emphasis about the variety of foods, the importance given to sustainabilityand the relationship of an unhealthy diet with excess intake of sugar, sweets, soft drinks, fast food and fats. The family was revealedas one of the most influential factors, followed by professionals, the media and high schools. Among the perceived barriers were thesocioeconomic level, lack of time, food supply in canteens and social pressure.Conclusions: The main barriers and motivations linked to the food environment, socioeconomic level, body image and emotio-nal well-being are identified. Adolescents express interest in participating in public policies.(AU)

Safety and efficacy of tirofiban in acute ischemic stroke due to tandem lesions undergoing mechanical thrombectomy: A multicenter randomized clinical trial (ATILA) protocol.

Background: In-stent thrombosis after mechanical thrombectomy (MT) worsen outcomes in acute ischemic stroke (AIS) due to tandem lesions (TL). Although an optimal antiplatelet therapy is needed, the best approach to avoid in-stent thrombosis is yet to be elucidated. Hypothesis: Low-dose intravenous tirofiban is superior to intravenous aspirin in avoiding in-stent thrombosis in patients undergoing MT plus carotid stenting in the setting of AIS due to TL. Methods: The ATILA-trial is a multicenter, prospective, phase IV, randomized, controlled (aspirin group as control), assessor-blinded clinical trial. Patients fulfilling inclusion criteria (AIS due to TL, ASPECTS ⩾ 6, pre-stroke modified Rankin Scale ⩽2 and onset <24 h) will be randomized (1:1) at MT onset to experimental (intravenous tirofiban) or control group (intravenous aspirin). Intravenous aspirin will be administered at a 500 mg single dose and tirofiban at a 500 µg bolus followed by a 200 µg/h infusion during first 22 h. All patients will be followed up to 3 months. Sample size estimated is 240 patients. Outcomes: The primary efficacy outcome is the proportion of patients with carotid in-stent thrombosis within the first 24 h after MT. The primary safety outcome is the rate of symptomatic intracranial hemorrhage. Secondary outcomes include functional independence defined as modified Rankin Scale 0-2, proportion of patients undergoing rescue therapy due to in-stent aggregation during MT and carotid reocclusion at 30 days. Discussion: ATILA-trial will be the first clinical trial regarding the best antiplatelet therapy to avoid in-stent thrombosis after MT in patients with TL. Trial registration: NCT0522596.

Comparing data from thrombectomy in m2 occlusion and proximal middle cerebral artery.

INTRODUCTION: Mechanical thrombectomy for large vessel occlusion in the anterior circulation has been shown to be beneficial. The question of whether this technique is safe and effective in the distal vasculature remains unanswered. We wanted to compare outcome data from mechanical thrombectomy of M2 branches of the middle cerebral artery (MCA) with those of the M1 segment, and better understand the clinical predictors of these M2 occlusions. METHODS: A retrospective analysis was performed of data prospectively collected between January 2017 and July 2021 from patients with acute ischemic stroke undergoing mechanical thrombectomy of isolated M1 or M2 branches of the MCA. RESULTS: 350 patients were identified, 287 with M1 and 63 with M2 occlusions. Mean age was 70.71 ± 12.55 and 75.21 ± 10.21 years, respectively (p = 0.0083). Baseline Alberta Stroke Program Computed Tomography (ASPECT) score was worse in the M1 cohort (7.68 ± 1.73 vs. 8.32 ± 1.54; p = 0.0079), while there was no significant difference in National Institutes of Health Stroke Scale (NIHSS) scores. No statistical disparity existed in mean procedure duration for each cohort; fewer thrombectomy attempts were required in the M2 cohort (2.01 vs. 1.63; p = 0.0478). There was no statistical difference in total time to recanalization (559.19 vs. 629.97, p = 0.2506). Similar rates of successful reperfusion were observed (Thrombolysis in Ischaemic Stroke score [TICI] ≥ 2b 80.84% vs. 71.43% p = 0.1221). Good outcome (modified Rankin scale ≤ 2) was 56.10 in M1 occlusions and 63.49% on M2 groups. Intracranial haemorrhage rates were similar. CONCLUSIONS: M2 thrombectomy is safe and a significant proportion of patients achieve a good clinical outcome. Advanced age, atrial fibrillation and previous treatment with anticoagulants were predictors for poor outcome. Good outcome was achieved when effective recanalization was obtained.

The Rhyacophila fasciata Species Complex (Trichoptera: Rhyacophilidae) in Central Europe with description of a new species, Rhyacophila loeffleri Valladolid & Waringer, n. sp., based on morphological, genetic and ecological evidence.

The morphology of the larva, pupa, male, and female of Rhyacophila loeffleri Valladolid & Waringer, n. sp., from Austria, Czech Republic, France, and Italy is described. Data from molecular analysis are also provided, based on mitochondrial cytochrome c oxidase subunit I (mtCOI), including sequences from German and Swiss specimens, and compared with those of samples of the nominate species R. fasciata Hagen 1859, as well as with other species and subspecies in the Rhyacophila fasciata Species Complex: R. septentrionis McLachlan 1865, R. denticulata McLachlan 1879, R. sociata Navs 1916, R. kykladica Malicky & Sipahiler 1993, R. delici Kuini & Valladolid 2020, R. fasciata viteceki Valladolid & Kuini 2020 and R. macedonica Karaouzas, Valladolid & Ibrahimi 2022. Our study revealed morphological differences between R. fasciata and R. loeffleri, as well as genetic differences among the other taxa of the R. fasciata Complex, supporting the recognition of R. loeffleri as a new species. Also, Rhyacophila fasciata viteceki is recognized as a distinct species, R. viteceki (status promotus), based on results of the molecular analysis.

Síndrome de burnout, resiliencia y miedo a la COVID-19 en personal sanitario durante la pandemia por SARS-CoV-2 / Burnout syndrome, resilience and fear of COVID-19 in healthcare professionals during the SARS-CoV-2 pandemic

Objetivo: describir la relación entre burnout, resiliencia y miedo frente a la COVID-19 del personal de salud que trabaja en la Gerencia de Atención Primaria de Toledo (GAPTO) durante la emergencia sanitaria por la pandemia por SARS-CoV-2. Diseño: estudio descriptivo, observacional y transversal. Emplazamiento: GAPTO, España. Participantes: 96 profesionales de medicina y enfermería de la GAPTO. Mediciones principales: se incluyeron las siguientes variables: características sociodemográficas, condiciones laborales, burnout, resiliencia y miedo a la COVID-19. Resultados: la prevalencia del burnout fue de 36,5%, el riesgo de desarrollar burnout fue de 28,1%. Un 50% de los profesionales tenía alterada la subescala de agotamiento emocional (AE), que puede estar asociada o no con alteraciones de las otras subescalas. Un 42,7% de la población estudiada mostró baja resiliencia. Un 45,8% tenía poco miedo a la COVID-19; un 43,8%, un miedo moderado, y un 10,4% presentaba altos niveles de miedo. Se encontró asociación inversa entre el síndrome de burnout y la resiliencia. También se observó relación entre el miedo a la COVID-19 y el burnout. La resiliencia y el miedo a la COVID-19 tienen una asociación más fuerte que el resto de las variables. Otras variables relacionadas con la presencia de burnout fueron la profesión y el servicio donde trabajan los profesionales. Conclusiones: el síndrome de burnout afectó a una elevada proporción de profesionales de la sanidad de la GAPTO en el marco de la pandemia por COVID-19, siendo el AE la subescala predominantemente afectada, que se encuentra relacionada con los niveles de resiliencia y de miedo a la COVID-19.(AU)

Objective: to report the relationship between burnout, levels of resilience and fear of COVID-19 in health professionals working in Toledo Primary Care Management (GAPTO) during the health emergency due to the SARS-CoV-2 pandemic. Design: descriptive, observational and cross-sectional study. Location: GAPTO, Spain. Participants: 96 GAPTO medical and nursing professionals. Main measurements: the variables included were: sociodemographic characteristics, working conditions, burnout, resilience and fear of COVID-19. Results: the prevalence of burnout syndrome was 36.5%, the risk of developing burnout was 28.1%. A total of 50% of professionals underwent an alteration on the emotional exhaustion subscale, which may or may not be associated with alterations on the other subscales. A total of 42.7% of the population shows low resilience; 45.8%, 43.8% and 10.4% have little, moderate and a high fear of COVID-19. An inverse association was detected between burnout syndrome and resilience. A relationship was also found between the fear of COVID-19 and burnout. Resilience and fear of COVID-19 have a stronger association than the rest of the variables. Other variables related to the presence of burnout were the profession and the department where the professionals work. Conclusions: burnout syndrome affects a high proportion of health professionals working in GAPTO, Spain, in the framework of the COVID-19 pandemic. Emotional exhaustion is the predominantly affected subscale, which is related to levels of resilience and fear of COVID-19.(AU)

The Rhyacophila fasciata Group in Europe: Rhyacophila macedonica Karaouzas, Valladolid amp; Ibrahimi (n. sp.) from Greece, Kosovo, Republic of North Macedonia and Serbia (Trichoptera: Rhyacophilidae).

The morphology of all postembryonic stages (larva, pupa, male, and female) of Rhyacophila macedonica Karaouzas, Valladolid, Ibrahimi n. sp. from Greece, Republic of North Macedonia, Kosovo and Serbia was examined. Morphological data were supplemented by a molecular analysis of the mitochondrial cytochrome C oxidase subunit I (COI) and compared with samples of the nominate species Rhyacophila fasciata Hagen 1859, as well as with other species and subspecies in this group: Rhyacophila septentrionis McLachlan 1865, Rhyacophila denticulata McLachlan 1879, Rhyacophila sociata Navs 1916, Rhyacophila kykladica Malicky Sipahiler 1993, Rhyacophila fasciata delici Kucinic Valladolid 2020, and Rhyacophila fasciata viteceki Valladolid Kucinic 2020. Our results revealed morphological differences between the nominate species and R. macedonica, as well as genetic differences among the taxa in the Rhyacophila fasciata Group, so we propose R. macedonica as a new species of the Group. Based on the new molecular data, we also elevate R. f. delici to the status of a distinct species, R. delici (status promotus).

Intra- or peri-procedural rupture in the endovascular treatment of intracranial aneurysms.

INTRODUCTION: Intra- or peri-procedural aneurysm rupture is one of the most feared adverse effects associated with embolization. Our aim was to report the characteristics of patients suffering intra- or peri-procedural ruptures during embolization of cerebral aneurysms. PATIENTS AND METHODS: Between March 1994 and October 2021, 648 consecutive cerebral aneurysms were treated by endovascular procedure at our facility. Medical records were reviewed retrospectively with emphasis on procedure description, potential risk factors, and clinical outcomes related to intra- or peri-procedural rupture. RESULTS: Of the 648 patients, 17 (2.6%) suffered an intra- or peri-procedural hemorrhagic event. The most common location was the anterior communicating artery. There was no significant difference between previously ruptured and unruptured aneurysms in the incidence of bleeding. In four patients, bleeding was evident within 24 h after the procedure. The clinical evolution at three months was poor and only four patients presented a positive evolution. There were 11 deaths (64.71%). Balloon remodeling was associated with an increased frequency of ruptures, while stenting was a safer treatment. CONCLUSION: Aneurysmal rupture during endovascular therapy is unpredictable, and its occurrence can be devastating. The incidence is quite low although the outcome is frequently poor. Early detection and proper management, including prompt occlusion of the aneurysm, are important to achieve a positive outcome. Anterior communicating artery aneurysms and those treated with balloon catheters have a higher incidence of rupture. A small number of ruptures of uncertain origin occur that go unnoticed in digital subtraction angiograms.

Addition of intracranial aspiration to balloon guide catheter does not improve outcomes in large vessel occlusion anterior circulation stent retriever based thrombectomy for acute stroke.

BACKGROUND: Balloon guide catheter (BGC) in stent retriever based thrombectomy (BGC+SR) for patients with large vessel occlusion strokes (LVOS) improves outcomes. It is conceivable that the addition of a large bore distal access catheter (DAC) to BGC+SR leads to higher efficacy. We aimed to investigate whether the combined BGC+DAC+SR approach improves angiographic and clinical outcomes compared with BGC+SR alone for thrombectomy in anterior circulation LVOS. METHODS: Consecutive patients with anterior circulation LVOS from June 2019 to November 2020 were recruited from the ROSSETTI registry. Demographic, clinical, angiographic, and outcome data were compared between patients treated with BGC+SR alone versus BGC+DAC+SR. The primary outcome was first pass effect (FPE) rate, defined as near complete/complete revascularization (modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3) after single device pass. RESULTS: We included 401 patients (BGC+SR alone, 273 (66.6%) patients). Patients treated with BGC+SR alone were older (median age 79 (IQR 68-85) vs 73.5 (65-82) years; p=0.033) and had shorter procedural times (puncture to revascularization 24 (14-46) vs 37 (24.5-63.5) min, p<0.001) than the BGC+DAC+SR group. Both approaches had a similar FPE rate (52% in BGC+SR alone vs 46.9% in BGC+DAC+SR, p=0.337). Although the BGC+SR alone group showed higher rates for final successful reperfusion (mTICI ≥2b (86.8% vs 74.2%, p=0.002) and excellent reperfusion, mTICI ≥2 c (76.2% vs 55.5%, p<0.001)), there were no significant differences in 24 hour National Institutes of Health Stroke Scale score or rates of good functional outcome (modified Rankin Scale score of 0-2) at 3 months across these techniques. CONCLUSIONS: Our data showed that addition of distal intracranial aspiration catheters to BGC+SR based thrombectomy in patients with acute anterior circulation LVO did not provide higher rates of FPE or improved clinical outcomes.

Stent-retriever alone versus combined use of stent-retriever and contact aspiration technique for middle cerebral artery M2 occlusions: a propensity score analysis.

BACKGROUND: The optimal endovascular treatment (EVT) technique for middle cerebral artery (MCA) M2 segment occlusions remains unknown. We aim to analyze whether reperfusion rate, procedure times, procedure-related complications, and clinical outcome differed between patients with isolated M2 occlusions who underwent stent-retriever (SR) alone versus combined SR and contact aspiration (CA) as a front-line EVT. METHODS: Patients who underwent EVT for isolated MCA-M2 occlusion were recruited from the prospectively ongoing ROSSETTI registry. Patients were divided regarding the EVT approach into SR alone versus SR+CA and propensity score matching was used to achieve baseline balance. Demographic, procedural, safety, and clinical outcomes were compared between groups. Multivariable logistic regression analysis was performed to identify independent predictors of first-pass effect (FPE) and 90-day modified Rankin scale (mRS) 0-2. RESULTS: 214 patients underwent EVT for M2 occlusion, 125 treated with SR alone and 89 with SR+CA. Propensity score matchnig analysis selected 134 matched patients. The rates of FPE (42% vs 40%, p=1.000) and 90-day mRS 0-2 (60% vs 51%, p=0.281) were comparable between groups. Patients treated with SR alone had lower need of rescue therapy (p=0.006), faster times to reperfusion (p<0.001), and lower procedure-related complications (p=0.031). Higher initial Alberta Stroke Program Early CT Score was an independent predictor of FPE. Age, baseline National Institutes of Health Stroke Scale score, and procedure duration were significant predictors of good clinical outcome at 3 months. CONCLUSIONS: As front-line modality in M2 occlusions, the SR alone approach results in similar rates of reperfusion and good clinical outcomes to combined SR+CA and might be advantageous due to faster reperfusion times and fewer adverse events.

The Rhyacophila fasciata Group in Europe: Rhyacophila fasciata Hagen 1859 and formerly synonymized species (Trichoptera: Rhyacophilidae), with new description of Rhyacophila fasciata and Rhyacophila septentrionis McLachlan 1865 (stat. prom.).

The presence and distribution of Rhyacophila fasciata Hagen 1859 in Europe were revised, based on bibliographic study, collection specimens, and new material collected in different countries. The status of formerly synonymized species, Rhyacophila ferruginea (Scopoli 1763) and Rhyacophila septentrionis McLachlan 1865 was also assessed. The type of R. ferruginea is missing, the taxon is still unidentified, and thus we propose Rhyacophila ferruginea as a nomen dubium. Morphological features and genetic evidence revealed that R. septentrionis differs from R. fasciata, so we propose to change its status to status resurrectus. We therefore include new descriptions of the different stages (larva, pupa, male, and female) of R. fasciata and of R. septentrionis, together with a molecular analysis based on mitochondrial cytochrome oxidase I (mtCOI) and ecological notes. The species R. coppai Oláh 2020 NEW SYNONYM and R. soreda Coppa Oláh 2020 NEW SYNONYM are synonyms of R. sociata Navás 1916; the species R. kopasa Oláh Coppa 2020 NEW SYNONYM and R. rova Oláh Coppa 2020 NEW SYNONYM are synonyms of R. denticulata McLachlan 1879; the species R. matrensis Oláh Szczesny 2020 is probably a synonym of R. fasciata, so more study of this species is needed in order to confirm or deny that it is a valid species.

Balloon guide catheter improvements in thrombectomy outcomes persist despite advances in intracranial aspiration technology.

BACKGROUND: First-pass effect (FPE) has been established as a key metric for technical success and strongly correlates with better clinical outcomes. Most data supporting improved outcomes with the use of a balloon guide catheter (BGC) predate the advent of last-generation large-bore intracranial aspiration catheters. We aim to evaluate the impact of BGC in FPE and clinical outcomes in a large cohort of patients treated with contemporary technology. METHODS: Patients were recruited from the prospectively ongoing ROSSETTI registry. This registry includes all consecutive patients with anterior circulation large-vessel occlusion (LVO) from 10 comprehensive stroke centers in Spain. Demographic, clinical, angiographic, and clinical outcome data were compared between BGC and non-BGC groups. FPE was defined as the achievement of mTICI2c-3 after a single device pass. RESULTS: 426 patients were included out of which 271 (63.62%) used BCG. BGC-treated patients had higher FPE rate (45.8% vs 27.7%; P<0.001), higher final mTICI ≥2 c recanalization rate (76.8% vs 50.3%, respectively; P<0.001), shorter procedural time [median (IQR), 30 (19-58) vs 43 (33-71) min; P<0.001], higher NIHSS difference from admission to 24 hours [median (IQR), 8 (2-12) vs 3 (0-10); P=0.001], and lower mortality rate (17.6% vs 29.8%, P=0.026) compared with non-BGC patients. BGC use was an independent predictor of FPE (OR 2.197, 95% CI 1.436 to 3.361; P<0.001), and excellent clinical outcome at 3 months (OR 0.34, 95% CI 0.17 to 0.68; P=0.002). CONCLUSIONS: Our results support the benefit of BGC use on angiographic and clinical outcomes in anterior circulation LVO ischemic stroke remain significant even when considering recent improvements in intracranial aspiration technology.

Resumption of endoscopy in the Galician colorectal cancer screening programme after the COVID-19 lock down: patient safety results.

The COVID-19 pandemic meant that the population-based colorectal cancer (CRC) screening programs had to be suspended. Modifications were made to the organization in order to reduce SARS-CoV-2 transmission. We report the experience of the Galician CRC screening program and patient safety results. Endoscopy was suspended between 13/03/2020 and 11/05/2020. After resumption, a total of 3,310 colonoscopies were performed (1,702 positive fecal occult blood tests and 1,608 endoscopy monitoring) and no SARS-CoV-2 infections were detected in the subsequent two weeks. Thus, resumption of activity associated with population screening was safe.

Endovascular stroke treatment after 6-24 hours only needs non-contrast CT.

OBJECTIVES: Imaging selected patients with proximal anterior circulation stroke who demonstrate limited infarct may benefit from endovascular treatment beyond conventional time limits. Our aim was to evaluate the results of the EVT group series arriving between 6 and 24 hours from the onset of symptoms with (ASPECTS) ≥7 to our hospital (with 24/7 interventional neuroradiology) comparing them with those obtained in our prospectively registered series arriving between 0 and 6 hours. MATERIALS AND METHODS: The inclusion criteria were ≥18 years, an interval between stroke and endovascular treatment of 6-24 hours, prestroke score mRS 0-2, no intracranial haemorrhage, (NIHSS) scale 8-22 and infarct evaluated by CT scan ≥7 in ASPECTS scale. Data, including patient demographics, neuroimaging findings, procedural details, recanalization rates and 90-day mRS, were collected. RESULTS: Twelve of the 14 (85.71%) endovascular group patients who came to our centre between 6 and 24 hours had good outcomes at 90 days. To confirm our findings, we evaluated patients treated at our centre who met the selection criteria from January 2017 to September 2019. In this period, 382 patients with large vessel occlusion were treated endovascularly. 56 patients met all the criteria for inclusion and exclusion for our study. 31 of these 56 patients (56.36%) obtained a (mRS) scale ≤2 at three months. There was no significant difference (P = 0.063). CONCLUSION: In circumstances of difficult access to MRI or CT perfusion, a computed tomography of ASPECTS ≥7 is sufficient to indicate endovascular treatment in a stroke of known onset between 6 and 24 hours.

The Rhyacophila fasciata Group in Croatia and Bosnia and Herzegovina: Rhyacophila f. fasciata Hagen 1859 and the description of two new subspecies, Rhyacophila fasciata delici Kucinic Valladolid (ssp. nov.) from Croatia and Bosnia and Herzegovina and Rhyacophila fasciata viteceki Valladolid Kucinic (ssp. nov.) from Bosnia and Herzegovina (Trichoptera: Rhyacophilidae).

We present the description of two new subspecies of the Rhyacophila fasciata Group: Rhyacophila fasciata delici Kucinic Valladolid (ssp. nov.), broadly distributed in Croatia and present also in Bosnia and Herzegovina, and R. fasciata viteceki Valladolid Kucinic (ssp. nov.), found in Bosnia and Herzegovina. Our study of the morphology of adults, as well as our analysis of the barcode region of the mitochondrial cytochrome oxidase I (mtCOI) gene and geographical distribution confirm the differences of the two new subspecies with the nominal species R. f. fasciata, also found in both countries.