Background and Purpose: Endovascular strategies provide unique opportunity to correlate angiographic measures of collateral circulation at the time of endovascular therapy. We conducted systematic analyses of collaterals at conventional angiography on recanalization, reperfusion and the clinical outcomes in the endovascular treatment arm of the Interventional Management of Stroke (IMS) III Trial. Methods: Prospective evaluation of angiographic collaterals was conducted via central review of subjects treated with endovascular therapy in IMS III (n=331). Collateral grade prior to endovascular therapy was assessed with the ASITN/SIR scale, blinded to all other data. Statistical analyses investigated the association between collaterals with baseline clinical variables, angiographic measures of recanalization, reperfusion and clinical outcomes. Results: Adequate views of collateral circulation to the ischemic territory were available in 276/331 (83%) subjects. Collateral grade was strongly related to both recanalization of the occluded arterial segment (p=0.0016) and downstream reperfusion (p<0.0001). Multivariable analyses confirmed that robust angiographic collateral grade was a significant predictor of good clinical outcome (mRS≤2) at 90 days (p=0.0353), adjusted for age, history of diabetes, NIHSS strata, and ASPECTS. The relationship between collateral flow and clinical outcome may depend on the degree of reperfusion. Conclusions: More robust collateral grade was associated with better recanalization, reperfusion, and subsequent better clinical outcomes. These data, from the largest endovascular trial to date, suggest that collaterals are an important consideration in future trial design.

Background: Heart transplantation in patients supported with ventricular assist devices (VADs) entails a high risk of injury at resternotomy. Prior femorofemoral bypass is the preferred approach in these patients, but poor venous drainage may restrict arterial flow rate. Patients and methods: We compared bypass parameters, transfusion requirements and postoperative outcome in 33 consecutive patients (40.4 AE 12.2 years old, 28 men) assisted with the Thoratec W paracorporeal VAD (mean duration, 3.0 AE 2.96 months) undergoing transplantation using either gravity siphon drainage (GSD, n = 16) or kinetic assisted venous drainage (KAVD, n = 17). Results: Cannulation technique, perfusion pressure, temperature and duration were similar between groups. There were no significant differences in arterial re-infusion flow rates (GSD, 3.6 AE 0.7 vs KAVD, 3.8 AE 0.6 l/min, p = 0.5). KAVD patients had a lower mean S v O 2 and a higher desaturation index than GSD patients (69.5 AE 4.6 vs 76.1 AE 5.4 mmHg, p = 0.004; and 0.63 AE 0.23 vs 0.25 AE 0.63, p = 0.0001, respectively). Perioperative requirements in fresh frozen plasma and platelet transfusions were significantly higher in KAVD patients. However, there were no differences in postoperative patient outcome. Conclusion: Perceived benefits on venous return associated with KAVD do not necessarily translate into improved arterial re-infusion flow rates and should be weighed against the hazards of increased venous air aspiration and blood product requirements. #

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The Study Aimed at : o Evaluating the level of psychological fluency among Iraqi female sports club players in volleyball. o Expounding the relationship between the level of psychological fluency and level of accomplishment among the study sample.

Backgroud: COVID-19 or the disease caused by the SARS -Cov2 -(sever acute respiratory syndrome caused by coronavirus 2 ). Coronavirus has caused a pandemic that has affected patients in more than 188 countries and territories around the world. Prodigious restrictions and safety measures have been adopted by the governments to control the spread of wildfire coronavirus disease 2019 (COVID-19) pandemic. However, the effective implementation of these measures depends upon the knowledge, attitudes, and practices (KAP) of the people. Materials and Methods:A cross-sectional survey was designed for the present study. The study was conducted from May 2020 to Septembet 2020 in Mosul city and include adults who are not working in the medical field and visit family medicine centers or hospitals for any reasons except having a disease Results: this study revealed that about (190) 95% of the participant knows that the disease can be spread by droplet of patient and (136) 68 % of them believe that surfaces touched by patient could be one of the measures to transmit the disease and (156) 78% of them said that the disease may transmited from asymptomatic patient. Regarding the knowledge of the participant about measures used to prevent spread of Covid 19 this research demonstrates that (198) 99% and (190) 95% of them convinced that proper hand wash and maintain appropriate distance between himself and other person specially with symptoms is an effective measure to prevent transmission of the disease . On the other hand , this study check the attitude of the participants toward Covid 19 which found that 76% and 72% of them have a good attitude toward covid 19 which was washing hands regularly and put facemask while only 59% believe that curfew during pandemic state are useful and 58% found that the preventive measures advised by health personnel were useful and 63% still considered that this disease designed as a biological weapon. Conclusions: According to this study about 65% of the participant have good knowledge , 63.4 % of them have good attitude a toward Covid 19 which is very important to limit it's transmission through the population .

Background: Collateral circulation has repeatedly been cited as a decisive factor in successful angiographic and clinical outcomes after endovascular therapy, offering rational selection criteria. Identifying patients with a malignant collateral profile, portending poor outcome, would greatly enhance decision-making in acute stroke. We analyzed the IMS III dataset to delineate baseline predictors of poor angiographic collaterals. Methods: Collateral grade was prospectively evaluated by the angiography core lab in IMS III. Poor collaterals or a malignant collateral profile was defined as ASITN grade 0-1. Baseline clinical, laboratory and non-contrast CT variables were evaluated in univariate and multivariable logistic regression as predictors of the malignant collateral profile. Results: 278 patients (mean age 65.3±12.6 years, 54% women, median NIHSS 17 (IQR 13-20) had collateral grading assessed at angiography. Malignant collaterals (ASITN 0-1) were noted in 77/278 (28%). Univariate analyses revealed that only history of HTN (88.3 vs. 71.0%, p=0.004), CHF (17.6 vs.8.0%, p=0.040), admission DBP (89±24 vs. 81±17 (mm Hg, mean±SD), p=0.002), NIHSS>19 (40.3 vs. 28.4%, p=0.080), distal arterial occlusion location (p=0.002) and ASPECTS 0-4 (24.7 vs. 9.4%, p=0.002) were associated with malignant collaterals. Time from stroke onset to angiography was unrelated to collateral grade. Predictors in multivariable analyses included ASPECTS 0-4 (OR 3.72, 95%CI (1.60-8.66), p=0.002), HTN (OR 2.33, 95%CI (1.01-5.38), p=0.047), NIHSS>19 (OR 2.26, 95%CI (1.16-4.40), p=0.017), distal arterial occlusion (OR 2.08, 95%CI (1.43-3.04), p<0.001) and higher admission DBP (OR 1.02 per mm Hg, 95%CI (1.00-1.03), p=0.035). When ASPECTS 5-10, only NIHSS>19 (OR 2.81, 95%CI (1.35-5.86), p=0.006) and distal arterial occlusion (OR 2.58, 95%CI (1.70-3.92), p<0.001) predicted malignant collaterals. Conclusions: Elevated diastolic blood pressure, history of hypertension, NIHSS>19, lower ASPECTS and distal arterial occlusion are strong predictors of the malignant collateral profile. Future studies should validate and implement a concomitant risk score for triage of acute stroke patients.