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Background: Mechanical thrombectomy (MT) has become first-line treatment for patients with acute ischemic stroke caused by large vessel occlusion (AIS-LVO). Delay in the interhospital transfer (IHT) of patients from referral hospitals to a comprehensive stroke center is associated with worse outcomes. At our academic tertiary care facility in an urban setting, a neurocritical care and emergency neurology unit (NCCU) receives patients with AIS-LVO from outlying medical facilities. When the NCCU is full, patients with AIS-LVO are initially transferred to a critical care resuscitation unit (CCRU). We were interested in quantifying the numbers of AIS-LVO patients treated in those two units and assessing their outcomes. We hypothesized that the CCRU would facilitate an increase in IHTs and provide care comparable to that delivered by the subspecialty NCCU.Methods: We conducted a retrospective study of the medical center's prospective stroke registry for adult IHT patients undergoing MT between 01/01/2015 and 12/31/2017. Primary outcome was time from consultation and request for transfer to arrival (Consult-Arrival). Other outcomes of interest were functional independence, defined as 90-day modified Rankin Scale (mRS) score ≤ 2, and 90-day all-cause mortality. Multivariable logistic regression was performed to assess association between clinical factors, mortality, and functional independence.Results: We analyzed the records of 128 IHT patients: 87 (68%) were admitted to the CCRU, and 41 (32%) to the NCCU. The two groups had similar baseline characteristics (age, National Institutes of Health Stroke Scale score, Alberta Stroke Program Early Computed Tomography scores [ASPECTS]). The median Consult-Arrival time was shorter for CCRU patients than for the NCCU patients (86 [88‒109] vs 100 [77‒127] [p = 0.031]). The 90-day mortality rates (16 vs 30% [p = 0.052]) and the rates having a mRS score ≤ 2 (31 vs 36% [p = 0.59]) were not statistically different. Multivariable logistic regression showed that each minute of delay in the Consult-Arrival time was associated with 2.3% increase in the likelihood of death (OR 1.023; 95% CI 1.003‒1.04 [p = 0.026]), while high thrombolysis in cerebral infarction score was the only factor that was significantly associated with functional independence at 90 days (OR 2.9; 95% CI 1.4‒6.4 [p = 0.006]).Conclusion: The CCRU increased AIS-LVO patients' access to definitive care and reduced their transfer time from outlying medical facilities while achieving outcomes similar to those attained by patients treated in the subspecialty NCCU. We conclude that a resuscitation unit can complement the NCCU to care for patients in the hyperacute phase of AIS-LVO. [ABSTRACT FROM AUTHOR]

Porcine distal colon epithelium was mounted in Ussing chambers and bathed in plasma-like Ringer solution. Tissue conductances ranged from 10 to 15 mS and the short-circuit current (I) ranged from-15 to 220 μA·cm. Variations in basal I resulted from differences in the amount of amiloride (10μ M mucosal addition)-sensitive Na absorption. Ion substitution and transepithelial flux experiments showed that 10 μ M amiloride produced a decrease in the mucosal-to-serosal (M-S) and net Na flux, and that this effect on I was independent of Cl and HCOreplacement. When the concentration of mucosal amiloride was increased from 10 to 100 μ M, little change in I was observed. However, increasing the concentration to 1 m M produced a further inhibition, which often reversed the polarity of the I. The decrease in I due to 1 m M amiloride was dependent on both Cl and HCO, and was attributed to reductions in the M-S and net Na fluxes as well as the M-S unidirectional Cl flux. Ion replacement experiments demonstrated that Cl substitution reduced the M-S and net Na fluxes, while replacement of HCOwith HEPES abolished net Cl absorption by reducing the M-S unidirectional Cl flux. From these data it can be concluded that: (1) Na absorption is mediated by two distinct amiloride-sensitive transport pathways, and (2) Cl absorption is completely HCO-dependent (presumably mediated by Cl/HCOexchange) and occurs independently of Na absorption. [ABSTRACT FROM AUTHOR]