Campbell, B. C.V. et al. (2019) Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data.ABSTRACT Background: CT-perfusion (CTP) and MRI may assist patient selection for endovascular thrombectomy. We aimed to establish whether imaging assessments of ischaemic core and penumbra volumes were associated with functional outcomes and treatment effect.

Campbell, B. C. V. et al. (2018) Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. Lancet Neurology, 17(1), pp. 47-53. (doi:10.1016/S1474-4422(17)30407-6) This is the author's final accepted version.There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it.http://eprints.gla.ac.uk/149670/ variables. An alternative approach using propensity-score stratification was also used. To account for between-trial variance we used mixed-effects modeling with a random effect for trial incorporated in all models. Bias was assessed using the Cochrane tool.Findings: Of 1764 patients in 7 trials, 871 were allocated to endovascular thrombectomy. After exclusion of 74 patients (72 who did not undergo the procedure and 2 with missing data on anaesthetic strategy), 236/797 (30%) of endovascular patients were treated under GA. At baseline, GA patients were younger and had shorter time to randomisation but similar pre-treatment clinical severity compared to non-GA. Endovascular thrombectomy improved functional outcome at 3 months versus standard care in both GA (adjusted common odds ratio (cOR) 1·52, 95%CI 1·09-2·11, p=0·014) and non-GA (adjusted cOR 2·33, 95%CI 1·75-3·10, p<0·001) patients. However, outcomes were significantly better for those treated under non-GA versus GA (covariate-adjusted cOR 1·53, 95%CI 1·14-2·04, p=0·004; propensitystratified cOR 1·44 95%CI 1·08-1·92, p=0·012). The risk of bias and variability among studies was assessed to be low.Interpretation: Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons. Funding:The HERMES collaboration was funded by an unrestricted grant from Medtronic to the University of Calgary. Research in contextEvidence before this study between abolition of the thrombectomy treatment effect in MR CLEAN and no effect in THRACE. Three single-centre randomised trials of general anaesthesia versus conscious sedation found either no difference in functional outcome between groups or a slight benefit of general anaesthesia. Added value of this studyThese data from contemporary, high quality randomised trials form the largest study to date of the association between general anesthesia and the benefit of endovascular thrombectomy versus standard care. We used two different approaches to adjust for baseline imbalances (multivariable logistic regression and propensity-score stratification). We found that GA for endovascular thrombectomy, as practiced in contemporary clinical care across a wide range of expert centres during the rand...

The study provides data on the rotational traction of shoe-surface interfaces currently employed in football. As football shoe and surface designs continue to be updated, new evaluations of their performance must be assessed under simulated loading conditions to ensure that player performance needs are met while minimizing injury risk.

Arbor. Dr Thomas is now with the Department of Kinesiology, University of Toledo, OH.Context: Quadriceps and hamstrings weakness occurs frequently after anterior cruciate ligament (ACL) injury and reconstruction. Evidence suggests that knee injury may precipitate hip and ankle muscle weakness, but few data support this contention after ACL injury and reconstruction.Objective: To determine if hip, knee, and ankle muscle weakness present after ACL injury and after rehabilitation for ACL reconstruction.Design: Case-control study. Setting: University research laboratory.Patients or Other Participants: Fifteen individuals with ACL injury (8 males, 7 females; age ¼ 20.27 6 5.38 years, height ¼ 1.75 6 0.10 m, mass ¼ 74.39 6 13.26 kg) and 15 control individuals (7 men, 8 women; age ¼ 24.73 6 3.37 years, height ¼ 1.75 6 0.09 m, mass ¼ 73.25 6 13.48 kg).Intervention(s): Bilateral concentric strength was assessed at 608/s on an isokinetic dynamometer. The participants with ACL injury were tested preoperatively and 6 months postoperatively. Control participants were tested on 1 occasion.Main Outcome Measures: Hip-flexor, -extensor, -abductor, and -adductor; knee-extensor and -flexor; and ankle-plantarflexor and -dorsiflexor strength (Nm/kg).Results: The ACL-injured participants demonstrated greater hip-extensor (percentage difference ¼ 19.7, F 1,14 ¼ 7.28, P ¼ .02) and -adductor (percentage difference ¼ 16.3, F 1,14 ¼ 6.15, P ¼ .03) weakness preoperatively than postoperatively, regardless of limb, and greater postoperative hip-adductor strength (percentage difference ¼ 29.0, F 1,28 ¼ 10.66, P ¼ .003) than control participants. Knee-extensor and -flexor strength were lower in the injured than in the uninjured limb preoperatively and postoperatively (extensor percentage difference ¼ 34.6 preoperatively and 32.6 postoperatively, t 14 range ¼À4.59 to À4.23, P .001; flexor percentage difference ¼ 30.6 preoperatively and 10.6 postoperatively, t 14 range ¼ À6.05 to À3.24, P , .05) with greater knee-flexor (percentage difference ¼ 25.3, t 14 ¼À4.65, P , .001) weakness preoperatively in the injured limb of ACLinjured participants. The ACL-injured participants had less injured limb knee-extensor (percentage difference ¼ 32.0, t 28 ¼ À2.84, P ¼ .008) and -flexor (percentage difference ¼ 24.0, t 28 ¼ À2.44, P ¼ .02) strength preoperatively but not postoperatively (extensor: t 28 ¼ À1.79, P ¼ .08; flexor: t 28 ¼ 0.57, P ¼ .58) than control participants. Ankle-plantar-flexor weakness was greater preoperatively than postoperatively in the ACL-injured limb (percentage difference ¼ 31.9, t 14 ¼ À3.20, P ¼ .006).Conclusions: The ACL-injured participants presented with hip-extensor, -adductor, and ankle-plantar-flexor weakness that appeared to be countered during postoperative rehabilitation. Our results confirmed previous findings suggesting greater knee-extensor and -flexor weakness postoperatively in the injured limb than the uninjured limb. The knee extensors and flexors are important dynamic stabilizers; weakness in these muscles could i...

Numerous studies on the mechanisms of ankle injury deal with injuries to the syndesmosis and anterior ligamentous structures but a previous sectioning study also describes the important role of the posterior talofibular ligament (PTaFL) in the ankle's resistance to external rotation of the foot. It was hypothesized that failure level external rotation of the foot would lead to injury of the PTaFL. Ten ankles were tested by externally rotating the foot until gross injury. Two different frequencies of rotation were used in this study, 0.5 Hz and 2 Hz. The mean failure torque of the ankles was 69.5+/-11.7 Nm with a mean failure angle of 40.7+/-7.3 degrees . No effects of rotation frequency or flexion angle were noted. The most commonly injured structure was the PTaFL. Visible damage to the syndesmosis only occurred in combination with fibular fracture in these experiments. The constraint of the subtalar joint in the current study may have affected the mechanics of the foot and led to the resultant strain in the PTaFL. In the real world, talus rotations may be affected by athletic footwear that may influence the location and potential for an ankle injury under external rotation of the foot.