Neurological outcomes for patients meeting radiographic criteria for DEFUSE 3 and SELECT2.

BACKGROUND: The DEFUSE 3 and SELECT2 thrombectomy trials included some patients with similar radiographic profiles, although the rates of good functional outcomes differed widely between the studies. OBJECTIVE: To report neurological outcomes for patients who meet CT and CT perfusion (CTP) inclusion criteria common to both DEFUSE 3 and SELECT2. METHODS: Retrospective study of thrombectomy patients, presenting between November 2016 and December 2023 to a large health system, with Alberta Stroke Program Early CT score ≥6, core infarction 50-69 mL, mismatch ratio ≥1.8, and mismatch volume ≥15 mL. The primary outcome was 90-day modified Rankin Scale score 0-2. A logistic regression analysis was performed to identify independent predictors of the primary outcome. RESULTS: 85 patients, with mean age 64.6 (16.6) years and median National Institutes of Health Stroke Scale score 18 (15-23), were included. Thirty-eight of 85 patients (44.7%) were functionally independent at 90 days. Predictors of functional independence included age (OR=0.943, 95% CI 0.908 to 0.980; P=0.003), initial glucose (OR=0.989, 95% CI 0.978 to 1.000; P=0.044), and time last known well to skin puncture (OR=0.997, 95% CI 0.994 to 1.000; P=0.028). The area under the curve for the multivariable model predicting the primary outcome was 0.82 (95% CI 0.73 to 0.92). CONCLUSION: Nearly half of patients meeting radiographic criteria common to DEFUSE 3 and SELECT2 are functionally independent at 90 days, similar to rates reported for the treated DEFUSE 3 cohort. This might be due to their moderate core volumes and large ischemic penumbra.

Predictors of devastating functional outcome despite successful basilar thrombectomy.

BACKGROUND: Basilar thrombosis frequently leads to poor functional outcomes, even with good endovascular reperfusion. We studied factors associated with severe disability or death in basilar thrombectomy patients achieving revascularization. METHODS: We retrospectively analyzed records from a health system's code stroke registry, including successful basilar thrombectomy patients from January 2017 to May 2023 who were evaluated with pretreatment computed tomography perfusion. The primary outcome was devastating functional outcome (90-day modified Rankin Scale [mRS] score 5-6). A multivariable logistic regression model was constructed to determine independent predictors of the primary outcome. The area under the receiver operator characteristics curve (AUC) was calculated for the model distinguishing good from devastating outcome. RESULTS: Among 64 included subjects, with mean (standard deviation) age 65.6 (14.1) years and median (interquartile range) National Institutes of Health Stroke Scale (NIHSS) 18 (5.75-24.5), the primary outcome occurred in 28 of 64 (43.8%) subjects. Presenting NIHSS (odds ratio [OR] 1.08, 95% confidence interval [CI] 1.01-1.14, p = 0.02), initial glucose (OR 0.99, 95% CI 0.97-1.00, p < 0.05), and proximal occlusion site (OR 7.38, 95% CI 1.84-29.60, p < 0.01) were independently associated with 90-day mRS 5-6. The AUC for the multivariable model distinguishing outcomes was 0.81 (95% CI 0.70-0.92). CONCLUSION: We have identified presenting stroke severity, lower glucose, and proximal basilar occlusion as predictors of devastating neurological outcome in successful basilar thrombectomy patients. These factors may be used in medical decision making or for patient selection in future clinical trials.

A 1.02 µW Battery-Less, Continuous Sensing and Post-Processing SiP for Wearable Applications.

Improving system lifetime and robustness is a key to advancing self-powered platforms for real world applications. A complete self-powered, battery-less, wearable platform requires a microwatt-power system-on-chip (SoC), operating reliably within this budget, capable of surviving long periods without charging, and recovering from power loss to its previous state. To meet these requirements, we designed a wireless sensing heterogeneous system-in-package (SiP) containing an ultra-low power (ULP) SoC, a non-volatile boot memory (NVM), and a 2.4 GHz frequency shift key (FSK) radio, all integrated with custom ULP interfaces. The SoC includes a fully integrated energy harvesting platform power manager (EH-PPM) to power the SiP and other commercial sensors. The EH-PPM is designed for small loads and powers the SoC and peripherals while drawing very low operating current. The SoC also includes a digital system data-flow for sensing applications, an analog front end for ECG signal acquisition, and a cold-boot management system (CBMS) for boot and recovery from the NVM. The CBMS enables integration of the SoC with the ULP NVM to create a wearable formfactor, self-powered system capable of recovery from power loss. The SoC also includes a radio interface tightly integrated with a compression accelerator to efficiently communicate with the FSK transmitter and reduce the FSK's transmission time. This tight integration between accelerators on the SoC and peripherals is another feature that reduces the system's power consumption by reducing the code size and number of memory accesses required to perform an operation. The SoC consumes 507 nW average power while running free-fall detection, 519 nW average power while measuring ambient temperature, and 1.02 µW during continuous ECG monitoring and post-processing.

In vitro degradation and cell attachment studies of a new electrospun polymeric tubular graft.

Electrospinning technique was utilized to engineer a small-diameter (id = 4 mm) tubular graft. The tubular graft was made from biocompatible and biodegradable polymers polycaprolactone (PCL) and poliglecaprone with 3:1 (PCL:PGC) ratio. Enzymatic degradation effect on the mechanical properties and fiber morphology in the presence of lipase enzyme were observed. Significant changes in tensile strength (1.86-1.49 MPa) and strain (245-205 %) were noticed after 1 month in vitro degradation. The fiber breakage was clearly evident through scanning electron microscopy (SEM) after 4 weeks in vitro degradation. Then, the graft was coated with a collagenous protein matrix to impart bioactivity. Human umbilical vein endothelial cells (HUVECs) and aortic artery smooth muscle cells (AoSMCs) attachment on the coated graft were observed in static condition. Further, HUVECs were seeded on the lumen surface of the grafts and exposed to laminar shear stress for 12 h to understand the cell attachment. The coated graft was aged in PBS solution (pH 7.3) at 37 °C for 1 month to understand the coating stability. Differential scanning calorimetry (DSC) and Fourier transform infrared spectroscopy (FTIR) suggested the erosion of the protein matrix from the coated graft under in vitro condition.

Fibro-porous poliglecaprone/polycaprolactone conduits: synergistic effect of composition and in vitro degradation on mechanical properties.

Blends of poliglecaprone (PGC) and polycaprolactone (PCL) of varying compositions were electrospun into tubular conduits and their mechanical, morphological, thermal and in vitro degradation properties were evaluated under simulated physiological conditions. Generally, mechanical strength, modulus and hydrophilic nature were enhanced by the addition of PGC to PCL. An in vitro degradation study in phosphate-buffered saline (pH 7.3) was carried out for up to 1 month to understand the hydrolytic degradation effect on the mechanical properties in both the longitudinal and circumferential directions. Pure PCL and 4:1 PCL/PGC blend scaffolds exhibited considerable elastic stiffening after a 1 month in vitro degradation. Fourier transform infrared spectroscopic and DSC techniques were used to understand the degradation behavior and the changes in structure and crystallinity of the polymeric blends. A 3:1 PCL/PGC blend was concluded to be a judicious blend composition for tubular grafts based on overall results on the mechanical properties and performance after a 1 month in vitro degradation study.