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Purpose: Anterior iris-claw phakic intraocular lens (pIOL) implantation is a treatment option for refractive, ametropic patients. However, the postoperative accommodative ability has not been systematically researched. Dynamic stimulation aberrometry allows the objective and dynamical measurement of accommodation by observing ocular aberrations during the accommodation process. We investigated the dynamic accommodative ability after pIOL implantation compared with a healthy age- and gender-matched control group. Design: Clinical, comparative case–control study. Subjects: We included patients aged 18–50 years that either underwent pIOL implantation > 1 month ago or served as a healthy, phakic control group. Methods: The accommodative ability and pupil dynamics of both groups were investigated using dynamic stimulation aberrometry. The method allows the analysis of dynamic parameters during accommodation, such as the accommodation speed. A 1:1 propensity score matching was conducted based on the patients’ age and gender. Main Outcome Measures: Parameters of objective accommodation, such as accommodative amplitude and pupil dynamic during accommodation. Results: Fifty-eight healthy, phakic eyes < 50 years of age and 21 eyes after pIOL implantation to correct myopia (pIOL, Verisyse, AMO, Inc) were enrolled. Patients that underwent anterior pIOL implantation were examined on average 24 ± 18 months after surgery. After matching, the mean age of both groups was not significantly different (35 ± 8 vs. 34 ± 8 years). No significant difference in dynamic parameters of accommodation or the accommodative amplitude (2.8 ± 1.4 and 2.9 ± 1.4 diopters [D] for pIOL and control group, P = 0.82) were seen. Maximum and minimum pupil sizes were not significantly different. The change in pupil size during deaccommodation was significantly faster in patients after pIOL implantation (P < 0.001). Conclusions: Dynamic stimulation aberrometry allowed the objective, dynamic, measurement of wavefronts in subjects with accommodative amplitudes up to 7 D. Phakic intraocular lens implantation does not impair the accommodative ability. It alters pupil dynamics during deaccommodation. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Summary: Gestational gigantomastia (GGM) is a rare condition characterized by a massive overgrowth of breast tissue during pregnancy. Surgical sanction may be required when conservative measures fail. In this study, we report the case of a 29-year-old woman who presented with an evolutive GGM responsible for physical and emotional distress, despite medical treatment. A multidisciplinary decision was made to induce delivery at 32 weeks. In the postdelivery period, the patient developed breast wounds, complicated with septic cardiomyopathy. An emergency bilateral mastectomy was then carried out, together with banking of both nipple-areola complexes. Thereafter, delayed bilateral 2-stage breast reconstruction was started at 12 months with subcutaneous tissue expanders, later on followed by implants removal and autologous reconstruction with bilateral deep inferior epigastric artery perforator flaps and bilateral nipple replantation.

Background: Postoperative analgesia after knee arthroplasty forms a basis for an optimal range of motion after surgery. Femoral nerve blocks are established as a sensory nerve blockade but at the expense of quadriceps weakness delaying postoperative mobilization. The adductor canal block (ACB) similarly provides sensory blockade but preserves quadriceps function. If ACB is performed intraoperatively, it would reduce the time and cost needed for ACBs. This study aimed at investigating possible landmarks making it feasible to perform ACB intraoperatively. Material and methods: Twenty-seven knees were used. The superior pole of the patella, medial epicondyle, and adductor tubercle was proposed as landmarks to perform the ACB through a medial parapatellar approach. A needle was directed toward the adductor tubercle until a tactile feedback was felt. Ten to 15 mL India ink were injected using this technique. The adductor canal was dissected to visualize the ink spread and determine whether the saphenous nerve and the nerve to vastus medialis were exposed to the ink. Results: The anatomic landmarks were easily identified in all knees. The ACB resulted in the saphenous nerve and nerve to vastus medialis being bathed in ink consistently. A volumetric relationship was noted with the injectate. No injury to the neurovascular structures was observed. Conclusions: An accurate and safe technique with reliable anatomic landmarks was presented to perform an ACB. In addition, an increase in injected ink volume correlated to an increase in the spread of ink; thus, we postulate that 10 mL of local anesthetic may be sufficient for an adequate regional block.

Background:. Ulnar styloid fractures (USFs) are often associated with distal radial fractures (DRFs). When unstable DRFs are treated surgically, any associated USF is most commonly left untreated. The purpose of this study was to evaluate the effect of a concomitant USF on outcome after surgical stabilization of a DRF. Methods:. Data from 2 randomized controlled trials on the treatment of unstable DRFs were pooled. The effect of a USF on the QuickDASH, EQ-5D, pain, and range of motion at 2 years was evaluated. Results:. Two hundred and eighty-one patients were included; 177 (63%) had an associated, untreated USF. An unadjusted analysis demonstrated no significant difference in functional or patient-reported outcome measures (PROMs) at 2 years between patients with or without a concomitant USF. When controlling for confounding factors, the presence of a USF did not predict change in any of the PROMs from baseline to 2 years. A concomitant USF also did not predict change in grip strength or range of motion, except for a small effect on extension (−4.1°; 95% confidence interval, −7.5° to −0.8°; p = 0.02), which probably does not have clinical relevance. Conclusions:. A USF in combination with a DRF does not affect PROMs, range of motion, or grip strength. We recommend that concomitant USFs be left untreated when treating a DRF with surgical fixation. Level of Evidence:. Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

Introduction Post-COVID-19 syndrome affects approximately 10-25% of people suffering from COVID-19 infection, irrespective of initial COVID-19 severity. Fatigue is one of the major symptoms, occurring in 30-90% of people with post-COVID-19 syndrome. This study aims at describing factors associated with fatigue in people with Post-COVID-19 seen in our newly established Post-Covid clinic. Methods This retrospective single center study included 42 consecutive patients suffering from Post-COVID-19 syndrome treated at the Department of Neurology, University Hospital Bern, between 11/2020 and05/2021. Clinical phenomenology of Post-COVID-19 syndrome with a special focus on fatigue and risk factor identification was performed using Mann-Whitney U Test, Pearson Correlation, and Chi-Quadrat-Test. Results Fatigue (90.5%) was the most prevalent Post-COVID-19 symptom followed by depressive mood (52.4%) and sleep disturbance (47.6%). Fatigue was in mean severe (Fatigue severity scale (FSS) mean 5.5 points (95% Confidence interval (95CI) 5.1 - 5.9, range .9 - 6.9, n = 40), and it was unrelated to age, COVID-19 severity or sex. The only related factors with fatigue severity were daytime sleepiness and depressed mood. Conclusion Fatigue is the main symptom of the Post-COVID-19 syndrome in our cohort. Further studies describing this syndrome are needed to prepare the healthcare systems for the challenge of treating patients with Post-COVID-19 syndrome.

Background:. Few studies have assessed long-term complications in women undergoing implant-based breast reconstruction with use of an acellular dermal matrix (ADM). This study compared outcomes over 5 years in women undergoing breast reconstruction procedures with and without ADM. Methods:. Complications data in patients enrolled in the prospective Continued Access Reconstruction/Revision Expansion trial were segregated by use of ADM versus no ADM in patients undergoing primary breast reconstruction or revision-reconstruction. Continued Access Reconstruction/Revision Expansion trial evaluated long-term safety and effectiveness of shaped, textured, silicone implants. Results:. Of the 9502 women, 257 had primary (n = 160) or revision-reconstruction (n = 97) with ADMs; 9245 had primary (n = 6977) or revision-reconstruction (n = 2268) without ADMs. Capsular contracture rates in primary reconstruction were lower with ADM than without at year 5 (3.2% versus 7.4%); rates were similar at year 1 (≤2.4%). Capsular contracture rates in revision-reconstruction were lower with ADM than without at year 5 (1.4% versus 8.9%); rates were similar at year 1 (≤2.5%). Seroma rates were low and sustained for all cohorts throughout the 5 years (≤2.9%). Reoperation rates increased over time in all cohorts, with similar rates between groups (2.4%–47.3% from week 4 to year 5 across cohorts). Other trends over time included lower rates for asymmetry and implant malposition with ADM than without. Conclusion:. These long-term data suggest that the use of ADM in breast reconstruction procedures may provide a benefit in reducing complications, such as capsular contracture, and may sustain low rates of seroma.

Background:. Prepectoral implant-based breast reconstruction is an alternative to subpectoral/dual-plane reconstruction. Methods:. This study examined outcomes of prepectoral reconstruction using a meta-analysis of data pooled with data from our previous review. Thirty studies were included. Results:. Explantation, seroma, and infection were the most common complications with no animation deformity reported. Significantly lower odds of infection were observed with prepectoral compared with dual-plane reconstruction. Conclusions:. Current literature suggests that prepectoral reconstruction may be associated with lower rates of postsurgical infections.

Immunoglobulin (Ig) G4-related disease is a recently described syndrome characterized by mass forming lymphoplasmacytic tissue infiltration and elevated serum IgG4 concentrations usually affecting middle-aged or older individuals. Lymphadenopathy is frequently observed and is sometimes the first or only manifestation of the disease. We report a case of IgG4-related disease mimicking Hodgkin lymphoma in a 13-year-old girl. The patient presented with progressive unilateral cervical lymphadenopathy of several months duration. Biopsy showed follicular hyperplasia with progressive transformation of germinal centers. Interfollicular areas were expanded by small lymphocytes, histiocytes, eosinophils and fibrosis with occasional CD30 positive cells initially concerning for interfollicular Hodgkin lymphoma. Immunohistochemical analysis revealed an intrafollicular plasmacytosis with an IgG4-positive/IgG-positive plasma cell ratio of 50% supporting a diagnosis of IgG4-related lymphadenopathy, progressively transformed germinal centers type. Laboratory studies were supportive with elevated serum IgG4 (178 mg/dL) and IgE (30.40 kU/L) levels along with an elevated serum IgG4/IgG ratio (0.16). Very few cases of IgG4-related disease have been described in children. Within this age group, there is considerable clinical overlap between IgG4-related disease associated lymphadenopathy and Hodgkin lymphoma. In addition, lymphadenopathy secondary to IgG4-related disease demonstrates substantial histologic diversity with the potential to simulate the inflammatory background and fibrosis of Hodgkin lymphoma. The importance of accurate diagnosis is underscored by the prognostic implications considering the marked response of the syndrome to steroid therapy. In addition, appropriate follow up is critical to monitor for relapse and additional organ involvement.

Context: Acute megakaryoblastic leukemia (AMKL) is a rare myeloid leukemia, occurring in 1%–5% of all adult acute myeloid leukemia (AML) cases. AMKL is characterized by a leukemic blast population positive for factor VIII, CD41a, CD42b, and/or CD61 with extensive myelofibrosis. Although various cytogenetic abnormalities are commonly reported, the association between constitutional trisomy 21 and AMKL has been of particular interest, because of the near universal presence of GATA1 mutation in such cases. Objective and Design: We report a case of AMKL in an adult presenting with extensive bone marrow necrosis in which cytogenetic studies revealed three copies of chromosome 21 as part of a complex karyotype; however, sequencing of the GATA1 gene revealed no mutation. Results: The patient was an adult male who presented with extensive bone marrow necrosis, making definitive diagnosis difficult. Autopsy studies using a multimodality approach identified AMKL with a complex karyotype, including trisomy 21. Sanger sequencing of the GATA1 gene showed a germline configuration without a mutation. Conclusions: To our knowledge, this is the first reported case of an adult with AMKL with acquired trisomy 21 in which the GATA1 mutation was investigated and the second reported case of AMKL presenting with extensive bone marrow necrosis. We will present a diagnostic approach to AMKL in which extensive bone marrow necrosis renders examination of the bone marrow difficult. Furthermore, we will examine the absence of the GATA1 mutation in a case of AMKL with trisomy 21 in an adult.

A geomagnetic jerk was seen in Swarm satellite data in 2017 over the Pacific region. We invert time series of spatial gradient secular variation data between 2014 and 2020, reduced to a grid of points at satellite altitude, for spatially- and temporally-regularized core surface flow. Pacific region flow acceleration was almost constant before and after the jerk, with a sharp change, especially in the azimuthal component, at the jerk epoch, despite the temporal regularization. Azimuthal acceleration is oppositely signed either side of 160°W, where it effectively vanishes, and also reverses sign at the jerk epoch. Acceleration features drift westward at about 900 km year -1 . Unlike previous studies, the evidence presented here for low latitude waves does not depend on imposing flow equatorial symmetry, quasi- or tangential geostrophy, or band-pass filtering, and has no reliance on stochastic models or numerical simulations., (© 2022. The Authors.)

Several studies show an increased risk of coronary heart disease (CHD) among people with obesity, but it is largely unknown whether this association also depends on a familial predisposition to obesity. This study examined if associations between Body Mass Index (BMI) or waist circumference (WC) and incident CHD differed among Danish female nurses with and without familial overweight and obesity. Analyses were based on data from the Danish Nurse Cohort (n = 20,701). Self-reported height, weight and self-measured WC were assessed in 1999, as was information on familial overweight/obesity, defined as having one or both parents with overweight/obesity. Information on the development of or death from CHD was collected from nationwide Danish registries in 2015. Analyses were based on Cox proportional hazard regression models adjusted for potential confounding factors. Both BMI and WC were directly associated with CHD risk, but we found no evidence of effect modification from familial predisposition to obesity. Hence a familial predisposition to obesity does not seem to influence the risk of CHD associated with general or central obesity., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

Objective: To determine the relationship between gout flare rate and self-categorization into remission, low disease activity (LDA), and patient acceptable symptom state (PASS)., Methods: Patients with gout self-categorized as remission, LDA, and PASS, and reported number of flares over the preceding 6 and 12 months. Multinomial logistic regression was used to determine the association between being in each disease state (LDA and PASS were combined) and flare count, and self-reported current flare. A distribution-based approach and extended Youden index identified possible flare count thresholds for each state., Results: Investigators from 17 countries recruited 512 participants. Remission was associated with a median recalled flare count of zero over both 6 and 12 months. Each recalled flare reduced the likelihood of self-perceived remission compared with being in higher disease activity than LDA/PASS, by 52% for 6 months and 23% for 12 months, and the likelihood of self-perceived LDA/PASS by 15% and 5% for 6 and 12 months, respectively. A threshold of 0 flares in preceding 6 and 12 months was associated with correct classification of self-perceived remission in 58% and 56% of cases, respectively., Conclusion: Flares are significantly associated with perceptions of disease activity in gout, and no flares over the prior 6 or 12 months is necessary for most people to self-categorize as being in remission. However, recalled flare counts alone do not correctly classify all patients into self-categorized disease activity states, suggesting that other factors may also contribute to self-perceived gout disease activity., (Copyright © 2021 by the Journal of Rheumatology.)

Objective: Compelling evidence supports a treat-to-target (T2T) strategy for optimal outcomes in rheumatoid arthritis (RA). There is limited knowledge regarding the factors that impede implementation of T2T, particularly in a setting where adherence to T2T is protocol-specified. We aimed to assess clinical factors that associate with failure to adhere to T2T., Methods: Patients with RA from 10 countries who were starting or changing conventional synthetic disease-modifying antirheumatic drugs and/or starting tumor necrosis factor inhibitors were followed for 2 years. Participating physicians were required per protocol to adhere to the T2T strategy. Factors influencing adherence to T2T low disease activity (T2T-LDA; 44-joint count Disease Activity Score ≤ 2.4) were analyzed in 2 types of binomial generalized estimating equations models: (1) including only baseline features (baseline model); and (2) modeling variables that inherently vary over time as such (longitudinal model)., Results: A total of 571 patients were recruited and 439 (76.9%) completed 2-year followup. Failure of adherence to T2T-LDA was noted in 1765 visits (40.5%). In the baseline multivariable model, a high number of comorbidities (OR 1.10, 95% CI 1.02-1.19), smoking (OR 1.32, 95% CI 1.08-1.63) and high number of tender joints (OR 1.03, 95% CI 1.02-1.04) were independently associated with failure to implement T2T, while anticitrullinated protein antibody/rheumatoid factor positivity (OR 0.63, 95% CI 0.50-0.80) was a significant facilitator of T2T. Results were similar in the longitudinal model., Conclusion: Lack of adherence to T2T in the RA BIODAM cohort was evident in a substantial proportion despite being a protocol requirement, and this could be predicted by clinical features. [Rheumatoid Arthritis (RA) BIODAM cohort; ClinicalTrials.gov: NCT01476956].

Objective: The Outcome Measures in Rheumatology Soluble Biomarker Working Group initiated an international, multicenter, prospective study, the Rheumatoid Arthritis (RA) BIODAM cohort, to generate resources for the clinical validation of candidate biomarkers predictive of radiographic progression. This first report describes the cohort, clinical outcomes, and radiographic findings., Methods: Patients with RA from 38 sites in 10 countries starting or changing conventional synthetic disease-modifying antirheumatic drugs and/or starting tumor necrosis factor inhibitors were followed for 2 years. Participating physicians were required to adhere to a treat-to-target strategy. Biosamples (serum, urine) were acquired every 3 months, radiography of hands and feet every 6 months, and ultrasound of hands and feet every 3 months in a subset. Primary endpoint was radiographic progression by the Sharp/van der Heijde score., Results: A total of 571 patients were recruited and 439 (76.9%) completed 2-year followup. At baseline, the majority was female (76%), mean age 55.7 years, and mean disease duration 6.5 years. Patients had a mean of 8.4 swollen and 13.6 tender joints, 44-joint count Disease Activity Score (DAS44) 3.8, 77.7% rheumatoid factor-positive or anticitrullinated protein antibody-positive. Percentage of patients in DAS and American College of Rheumatology remission at 2 years was 52.2% and 27.1%, respectively. Percentage of patients with radiographic progression (> 0.5) at 1 and 2 years was 38.2% and 59.9%, respectively., Conclusion: The RA BIODAM prospective study succeeded in generating an extensive list of clinical, imaging (2343 radiographs), and biosample (4638 sera) resources that will be made available to expedite the identification and validation of biomarkers for radiographic damage endpoints. (Clinicaltrials.gov: NCT01476956, clinicaltrials.gov/ct2/show/NCT01476956).

We present the geomagnetic field model COV-OBS.x2 that covers the period 1840-2020. It is primarily constrained by observatory series, satellite data, plus older surveys. Over the past two decades, we consider annual differences of 4-monthly means at ground-based stations (since 1996), and virtual observatory series derived from magnetic data of the satellite missions CHAMP (over 2001-2010) and Swarm (since 2013). A priori information is needed to complement the constraints carried by geomagnetic records and solve the ill-posed geomagnetic inverse problem. We use for this purpose temporal cross-covariances associated with auto-regressive stochastic processes of order 2, whose parameters are chosen so as to mimic the temporal power spectral density observed in paleomagnetic and observatory series. We aim this way to obtain as far as possible realistic posterior model uncertainties. These can be used to infer for instance the core dynamics through data assimilation algorithms, or an envelope for short-term magnetic field forecasts. We show that because of the projection onto splines, one needs to inflate the formal model error variances at the most recent epochs, in order to account for unmodeled high frequency core field changes. As a by-product of the core field model, we co-estimate the external magnetospheric dipole evolution on periods longer than 2 years. It is efficiently summarized as the sum of a damped oscillator (of period 10.5 years and decay rate 55 years), plus a short-memory (6 years) damped random walk., Competing Interests: Competing interestsThe authors declare having no competing interest., (© The Author(s) 2020.)

We present the CHAOS-7 model of the time-dependent near-Earth geomagnetic field between 1999 and 2020 based on magnetic field observations collected by the low-Earth orbit satellites Swarm , CryoSat-2, CHAMP, SAC-C and Ørsted, and on annual differences of monthly means of ground observatory measurements. The CHAOS-7 model consists of a time-dependent internal field up to spherical harmonic degree 20, a static internal field which merges to the LCS-1 lithospheric field model above degree 25, a model of the magnetospheric field and its induced counterpart, estimates of Euler angles describing the alignment of satellite vector magnetometers, and magnetometer calibration parameters for CryoSat-2. Only data from dark regions satisfying strict geomagnetic quiet-time criteria (including conditions on IMF B z and B y at all latitudes) were used in the field estimation. Model parameters were estimated using an iteratively reweighted regularized least-squares procedure; regularization of the time-dependent internal field was relaxed at high spherical harmonic degree compared with previous versions of the CHAOS model. We use CHAOS-7 to investigate recent changes in the geomagnetic field, studying the evolution of the South Atlantic weak field anomaly and rapid field changes in the Pacific region since 2014. At Earth's surface a secondary minimum of the South Atlantic Anomaly is now evident to the south west of Africa. Green's functions relating the core-mantle boundary radial field to the surface intensity show this feature is connected with the movement and evolution of a reversed flux feature under South Africa. The continuing growth in size and weakening of the main anomaly is linked to the westward motion and gathering of reversed flux under South America. In the Pacific region at Earth's surface between 2015 and 2018 a sign change has occurred in the second time derivative (acceleration) of the radial component of the field. This acceleration change took the form of a localized, east-west oriented, dipole. It was clearly recorded on ground, for example at the magnetic observatory at Honolulu, and was seen in Swarm observations over an extended region in the central and western Pacific. Downward continuing to the core-mantle boundary, we find this event originated in field acceleration changes at low latitudes beneath the central and western Pacific in 2017., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Objective: To analyze the association between enthesitis, synovitis, and peritenon extensor tendon inflammation (PTI) in psoriatic arthritis (PsA)., Methods: PsA patients with swelling of metacarpophalangeal joints were included. Greyscale and power Doppler (PD) were used for synovitis and PTI ultrasound identification. Madrid Sonographic Enthesis Index (MASEI) was used for enthesitis assessment. PD activity was evaluated using PD item of MASEI and PD Outcome Measures in Rheumatology (OMERACT) definition., Results: Synovitis had no association with enthesitis. PTI was associated with PD MASEI and PD OMERACT. Only PD OMERACT showed a positive correlation with PTI., Conclusion: In PsA, PTI is associated to enthesitis, as opposed to synovitis.

Objective: The Outcome Measures in Rheumatology (OMERACT) Ultrasound (US) Working Group (WG) operates research activities for the validation of US as an outcome measurement instrument according to the Filter 2.0 framework., Methods: Original publications on definitions and scoring systems for pathophysiological manifestations and elementary lesions of various rheumatic disorders were reviewed from the onset of the WG research in 2005., Results: Definitions and scoring systems according to new terminology are provided., Conclusion: We have redefined OMERACT US pathology and elementary lesions as well as scoring systems, which are now proposed for OMERACT approval for application in clinical trials.

Objective: To evaluate the intraobserver and interobserver reliability of the ultrasonographic (US) assessment of subtalar joint (STJ) synovitis in patients with rheumatoid arthritis (RA)., Methods: Following a Delphi process, 12 sonographers conducted an US reliability exercise on 10 RA patients with hindfoot pain. The anteromedial, posteromedial, and posterolateral STJ was assessed using B-mode and power Doppler (PD) techniques according to an agreed US protocol and using a 4-grade semiquantitative grading score for synovitis [synovial hypertrophy (SH) and signal] and a dichotomous score for the presence of joint effusion (JE). Intraobserver and interobserver reliability were computed by Cohen's and Light's κ. Weighted κ coefficients with absolute weighting were computed for B-mode and PD signal., Results: Mean weighted Cohen's κ for SH, PD, and JE were 0.80 (95% CI 0.62-0.98), 0.61 (95% CI 0.48-0.73), and 0.52 (95% CI 0.36-0.67), respectively. Weighted Cohen's κ for SH, PD, and JE in the anteromedial, posteromedial, and posterolateral STJ were -0.04 to 0.79, 0.42-0.95, and 0.28-0.77; 0.31-1, -0.05 to 0.65, and -0.2 to 0.69; 0.66-1, 0.52-1, and 0.42-0.88, respectively. Weighted Light's κ for SH was 0.67 (95% CI 0.58-0.74), 0.46 (95% CI 0.35-0.59) for PD, and 0.16 (95% CI 0.08-0.27) for JE. Weighted Light's κ for SH, PD, and JE were 0.63 (95% CI 0.45-0.82), 0.33 (95% CI 0.19-0.42), and 0.09 (95% CI -0.01 to 0.19), for the anteromedial; 0.49 (95% CI 0.27-0.64), 0.35 (95% CI 0.27-0.4), and 0.04 (95% CI -0.06 to 0.1) for posteromedial; and 0.82 (95% CI 0.75-0.89), 0.66 (95% CI 0.56-0.8), and 0.18 (95% CI 0.04-0.34) for posterolateral STJ, respectively., Conclusion: Using a multisite assessment, US appears to be a reliable tool for assessing synovitis of STJ in RA.

Background and Purpose: In patients identified at referring facilities with acute ischemic stroke caused by a large vessel occlusion, bypassing the emergency department (ED) with direct transport to the neuroangiography suite may safely shorten reperfusion times., Methods: We conducted a single-center retrospective review of consecutive patients transferred to our facility for consideration of endovascular therapy. Patients were identified as admitted directly to the neuroangiography suite (DAN), transferred to the ED before intra-arterial therapy (ED-IA), and transferred to the ED but did not receive IA therapy (ED-IV)., Results: A retrospective review of a prospectively maintained database of transfer patients between January 2013 and October 2016 with large vessel occlusions identified 108 ED-IV patients and 261 patients who underwent mechanical thrombectomy (DAN=111 patients and ED-IA=150 patients). There were no differences in baseline characteristics among the 3 groups. The median computed tomography ASPECTS (Alberta Stroke Program Early CT Score) was lower in the ED-IV group versus the ED-IA and DAN groups (8 versus 9; P =0.001). In the DAN versus ED-IA cohort, there were comparable rates of TICI2b/3 recanalization and access to recanalization time. There was significantly faster hospital arrival to groin access time in the DAN cohort (81 minutes versus 22 minutes; P =0.001). Functional independence at 90 days was comparable in the DAN versus ED-IA cohorts but worse in the ED-IV group (43% versus 44% versus 22%; P =0.001)., Conclusions: DAN is safe, feasible, and associated with faster times of hospital arrival to recanalization. The clinical benefit of this approach should be assessed in a prospective randomized trial., (© 2017 American Heart Association, Inc.)

An established conceptualization of visual cortical function is one in which ventral regions mediate object perception while dorsal regions support spatial information processing and visually guided action. This division has been contested by evidence showing that dorsal regions are also engaged in the representation of object shape, even when actions are not required. The critical question is whether these dorsal, object-based representations are dissociable from ventral representations, and whether they play a functional role in object recognition. We examined the neural and behavioral profile of patients with impairments in object recognition following ventral cortex damage. In a functional magnetic resonanace imaging experiment, the blood oxygen level-dependent response in the ventral, but not dorsal, cortex of the patients evinced less sensitivity to object 3D structure compared with that of healthy controls. Consistently, in psychophysics experiments, the patients exhibited significant impairments in object perception, but still revealed residual sensitivity to object-based structural information. Together, these findings suggest that, although in the intact system there is considerable crosstalk between dorsal and ventral cortices, object representations in dorsal cortex can be computed independently from those in ventral cortex. While dorsal representations alone are unable to support normal object perception, they can, nevertheless, support a coarse description of object structural information., (© The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

The use of telecommunications technology to provide the healthcare services, telemedicine, has been in use since the 1860s. The use of technology has ranged from providing medical care to far-off places during wartimes to monitoring physiological measurements of astronauts in space. Since the 1990s, reports have been published on diagnoses of neurological diseases with the use of video links. Studies confirm that the neurological examinations, including the National Institutes of Health Stroke Scale, performed during teleneurology are dependable. The transfer of stroke patients in rural hospitals to bigger medical centers delays treatment while there exists current and projected shortage of neurologists. Telestroke provides the solution. Patients suspected of acute stroke need a noncontrast computerized tomography (CT) scan for tissue plasminogen activator administration. Vascular imaging such as CT angiography, magnetic resonance angiography, and digital subtraction angiography can help show large-vessel occlusion or critical stenosis responsive to endovascular therapy. A standard protocol can be followed to decide a vascular modality of choice, considering advantages and disadvantages of each imaging modality. Telestroke solves the problems of distance and of shortage of neurologists. Neuroimaging plays a vital role in the delivery of telestroke, and the telestroke doctor should be comfortable with making a decision on selecting an appropriate vascular imaging modality., (Copyright © 2016 by the American Society of Neuroimaging.)

Objectives: Spontaneous intracerebral hemorrhage (ICH) results in high morbidity and mortality. A target for therapy might be hematoma expansion, which occurs in a significant proportion of patients, and can be exacerbated by antiplatelet medications, such as aspirin. It is not clear whether platelet transfusion neutralizes aspirin. The Aspirin Response Test (ART) is commonly ordered in this patient population, but it is not clear whether the results of this test can help select patients for transfusion of platelets. The aim of our study is to investigate whether a selected group of ICH patients, those with reduced platelet activity ("aspirin responders"), will benefit from platelet transfusion., Materials and Methods: This retrospective study included 63 patients who were taking aspirin but no other antithrombotic medication prior to the ICH. For each patient, we measured hematoma size by head CT on admission and compared with follow-up head CT 1 day later., Results: In the general cohort, 41% of transfused patients and 29% of non-transfused patients had a hematoma expansion. In the "aspirin responders" group, 46% of transfused patients and 22% of non-transfused patients had an expansion., Conclusions: Our data suggest that platelet transfusion following an ICH in "aspirin responders" does not reduce hematoma expansion rates in those patients. A larger prospective study is needed., (Copyright © 2015 Elsevier B.V. All rights reserved.)