Background: Mechanical thrombectomy with stenttriever devices is associated with significantly better outcomes than thrombolysis alone in the treatment of acute ischaemic stroke. Thrombus aspiration achieves high patency rates, but clinical outcomes are variable. The aim of this study was to examine the effect of different suction conditions on perfusate flow during aspiration thrombectomy.
Results:The mathematical model predicted that in a patent vessel perfusate is drawn from upstream of the catheter tip, while in an occluded system perfusate is drawn from the vessel proximal to the device tip, with no traction on the occlusion distal of the tip. The in-vitro experiments confirmed the predictions of this model. In the occluded vessel aspiration had no effect on the thrombus unless the tip of the catheter was in direct contact with the thrombus.
Conclusion:These experiments suggest that aspiration is only effective if the catheter tip is in direct contact with the thrombus. If the catheter tip is not in contact with the thrombus aspirate is drawn from the vessels proximal of the occlusion. This could affect collateral flow in vivo.
Background
The COVID-19 pandemic has created a hiatus in in-person clinical assessments due to safety and logistical concerns. We aimed to evaluate student perception and utility of an online Integrated Structured Clinical Examinations (ISCEs) during the pandemic.
Methods
Final-year medical students from a single institution were offered an online mock ISCE through a student-to-student (“near-peer”) teaching-programme. A questionnaire-based cross-sectional study was conducted pre- and post-online mock ISCE.
Results
Sixty-four students completed the study. Pre- and post-data showed an increase in confidence (p<0.0001), less worry regarding the online format (p<0.0001) and less anxiety about excelling in ISCEs (p<0.001). Students felt that having done the mock, an online format would more positively affect their overall performance (p=0.007).
Conclusion
This study demonstrates a positive change in student perception and confidence in online ISCEs. Online ISCEs are thus feasible, though sole reliance on this format may provide an incomplete assessment of student’s overall clinical competency.
BackgroundGraves' orbitopathy has a profound negative impact on quality of life. Surgery is undertaken to preserve vision, correct diplopia and improve aesthetics. We sought to quantify the effect of different surgical approaches on quality of life.
MethodsElectronic databases Ovid-MEDLINE, EMBASE were used from inception until 22 nd March, 2021 to identify studies assessing quality of life pre-and post-surgical intervention for Graves' orbitopathy. Two reviewers independently extracted data and performed quality assessments.Random-effects and Bayesian models for meta-analyses were utilised.
Results10 articles comprising 632 patients with a mean age of 48.4 years (range 16-85 years) were included. All used the Graves' Ophthalmopathy Quality of Life questionnaire (GO-QOL). For GO-QOL appearance, the pooled standardised mean improvement for patients after surgery was +0.72 (95% CI 0.50-0.94) I 2 69% (95% CI 52-80%). For GO-QOL visual functioning, the pooled SMD for patients after surgery was +0.41 (95% CI 0.25-0.58) I 2 60% (95% CI 36-74%).For visual appearance, orbital decompression yielded the greatest improvement (SMD +0.84, 95% CI 0.54-1.13) followed by eyelid surgery (SMD +0.38, 95% CI 0.05-0.70), while strabismus correction had no significant effect (SMD +0.94, 95% CI -0.10-1.99). Conversely strabismus correction was associated with the greatest improvement (SMD +1.25, 95% CI 0.29-2.
Background: HTLV-1/2 mother-to-child transmission (MTCT) is an important route for the maintenance of HTLV-1/2 within populations and disproportionally contributes to the burden of HTLV-1-associated diseases. Avoidance of breastfeeding is the safest recommendation to prevent MTCT. Due to the benefits of breastfeeding, alternative methods that would allow seropositive mothers to breastfeed their babies are needed. There is limited knowledge about HTLV-1/2 infection and breastmilk. Methods: Paired blood and milk samples collected from HTLV-1/2 seropositive mothers were tested for HTLV-1 proviral load (PVL) quantification and for the detection of anti-HTLV-1/2 IgG. Results: All breastmilk samples had detectable anti-HTLV-1/2 IgG. HTLV-1/2 proviral DNA was detected in all samples except for one. HTLV-1 PVL and IgG binding ratio (BR) was similar in milk and plasma. However, antibody titer was significantly higher in blood (Median (95%CI): Milk:128 (32–512); Plasma:131,584 (16,000–131,584), p < 0.05). There was a strong correlation between HTLV-1 PVL, anti-HTLV-1/2 IgG BR, and titer when comparing milk and blood. PVL did not correlate with antibody BR nor titer in blood or milk. Conclusions: Anti-HTLV-1/2 IgG are present in milk in the same proportion as blood but in lower quantity. PVL in milk correlates with blood.
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