Drain snake failure

 My Mom had a plugged toilet and since plungers didn't work I had to get a drain snake.  The S-bar is held in both hands with a twisting motion to turn the snake. I was able to get the left thumb open enough to get it around the handle but as soon as that occurred the fingers clasped even tighter. After much swearing the fingers had to be opened first and then the thumb. Nothing my therapists did prepared me for dealing with spasticity. The snake didn't work since there seemed to be a complete blockage. A plumber will need to be called, prior to stroke I could easily have pulled the toilet and figured out the solution.

New made-in-Indiana technology is helping stroke and spinal cord injury patients regain function in their hands.

3.5  minute YouTube video. Your non-functioning doctor probably can't figure a common household item that could mimic this. Ask him/her to test out their competence.

 New made-in-Indiana technology is helping stroke and spinal cord injury patients regain function in their hands.

World’s first self-stabilising walking exoskeleton enters stroke rehab trial

Doesn't your competent hospital already have the best of these walking assistants? 

Ask your doctor how this compares to all the other walking assist devices out there.

• walking (567)

• walking aids (1)

• walking assist (6)

• walking bike (1)

• walking capacity (1)

• walking endurance (1)

• walking frame (1)

• Walking o’Clock (1)

• walking pace (3)

• walking pattern (1)

• walking resistance (1)

• walking speed (7)

World’s first self-stabilising walking exoskeleton enters stroke rehab trial

Atalante X is designed to support people with mobility issues

September 25, 2023 - 10:54 am

The world’s first self-stabilising walking exoskeleton, Atlante X,  has entered a rehabilitation trial in Germany.

The exoskeleton will be provided to patients with hemiparesis, an after-effect of stroke that causes muscle weakness on one side of the body. Atalante X’s efficacy will be compared with standard rehabilitation methods.

The trial, named EarlyExo, will take place at two renowned neurorehabilitation clinics: the Vivantes Klinikum Spandau in Berlin and Schön Klinik Bad Aibling Harthausen near Munich. Both clinics will this month begin recruiting a total of 66 patients.

“Recovery from a stroke and other acute neurological conditions is complex and can take patients, treating therapists, physicians, and carers significant time, effort, and resources,” Professor Jörg Wissel, a neurologist at Vivantes Klinikum Spandau, said in a statement.

The <3 of EU tech

The latest rumblings from the EU tech scene, a story from our wise ol' founder Boris, and some questionable AI art. It's free, every week, in your inbox. Sign up now!

• I agree to allow TNW to store and process my personal data

  *

“We look forward to evaluating the potential impact that Atalante X can add in helping patients recover walking ability, trunk stability, balance, weight transfer, and limb function.”

Atalante X enables multitasking via various exercises from an upright position. Credit: Wandercraft

Atalante X was developed by Wandercraft, a healthtech firm based in Paris. Founded in 2012, the company wants to build a better solution for people deprived of walking than a wheelchair. Its opening proposal, Atalante, was launched in 2019. Wandercraft believes it was the first bipedal walking robot to become a full commercial product.

Atalante X is the second iteration of the tool. Using a proprietary self-balancing feature, the exoskeleton provides hands-free and multi-directional locomotion. Therapists can use the device to personalise task-orientated treatments for each patient’s needs.

Regulators have shown growing faith in the system. In January, the US Food and Drug Administration (FDA) cleared Atalante for use in stroke rehabilitation. Investors have also provided strong support, ploughing a total of around $67mn (€63mn) into Wandercraft.

The trial in Germany provides another opportunity to develop the product.

“This launch in one of Europe’s largest markets reinforces the position of Wandercraft as a global leader in the field of self-stabilizing, assisted locomotion,” said Matthieu Masselin, CEO of Wandercraft.

“It helps provide us with the opportunity to extend the reach of our assistive technology to greater patient populations for treatment and rehabilitation.”

The German launch expands Wandercraft’s strong commercial presence in Europe, which also includes footholds in France and Spain.  The company is now targeting the biggest market of them all: the USA.

Machine learning model able to better predict AD from driving data, biomarkers

 

Because of your extra risk of dementia from your stroke, does your hospital have enough functioning brain cells to get this? 

Do you prefer your hospital incompetence NOT KNOWING OR NOT DOING anything on this?

Your risk of dementia, has your doctor told you of this?  Your doctor is responsible for preventing this!

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.

2. Then this study came out and seems to have a range from 17-66%. December 2013.`    

3. A 20% chance in this research.   July 2013.

4. Dementia Risk Doubled in Patients Following Stroke September 2018 

The latest here:

Machine learning model able to better predict AD from driving data, biomarkers

Key takeaways:

• The study included 139 adults aged 65 years and older to drive vehicles for 1 year.
• When a machine learning model was applied, more variables meant greater prediction accuracy for preclinical Alzheimer’s.

PHILADELPHIA — A machine learning model was better able to predict preclinical Alzheimer’s disease from participant biomarkers as well as driving data from a year-long study, according to a speaker.

“As we age, there are declines in sensory and motor abilities and when we think about driving, it really is one of the most complex activities that most of us do,” Ganesh M. Babulal, PhD, OTD, MSCI, an associate professor in the department of neurology at Washington University School of Medicine, said during his presentation at the American Neurological Association annual meeting. “It requires sustained and dynamic engagement.”

According to research, a machine learning model was better able to predict preclinical Alzheimer’s disease with more variables taken from information of cognitively normal older adults whose vehicles were chipped for 1 year. Image: Adobe Stock

Babulal and colleagues sought to identify older drivers at risk of cognitive decline and at risk for accidents and crashes, and to do so before cognitive decline occurs.

In the first 4 years of their research, the researchers found those with preclinical AD as measured by positive readings on amyloid or cerebrospinal fluid (CSF) biomarker testing made 2.5 more errors on a standard road test and were faster to fail a road test although remaining cognitively normal.

Their current study involved the DRIVES program, in which each 139 adults aged 65 years and older who were deemed cognitively normal as measured by the Clinical Dementia Rating scale, required to drive a non-adaptive vehicle with a valid driver’s license at least once per week.

Each participant had their vehicle fitted with a chip that for 1 year measured latitude and longitude for each vehicle as well as the number of trips, miles, unique destinations along with speed, the number of instances of hard braking and sudden acceleration. An accelerometer also measured the kind of accident impact as well as level of accident impact as either minor or major. All participants with CSF data were categorized as positive or negative and logistic regression models were employed to measure area under the curve. A machine learning model was applied with data to further analyze AUC with respect to biomarkers predicting preclinical disease.

According to results, when more variables were added to analysis, the more closely the AUC approached 1, indicating greater accuracy for preclinical disease prediction. When driving, baseline age, APOE, e4 status, race and gender were factored, AUC reached 0.963, compared with 0.774 when only driving was analyzed.

“Plasma biomarkers have really been the holy grail for Alzheimer’s disease,” Babulal said. “These are data that’s easily captured on any patient.”

FDA grants 510(k) clearance for Alzheimer’s, dementia diagnosis software

Because of your extra risk of dementia from your stroke, does your hospital have enough functioning brain cells to get this software? 

Do you prefer your hospital incompetence NOT KNOWING OR NOT DOING anything on this?

Your risk of dementia, has your doctor told you of this?  Your doctor is responsible for preventing this!

1. A documented 33% dementia chance post-stroke from an Australian study?   May 2012.

2. Then this study came out and seems to have a range from 17-66%. December 2013.`    

3. A 20% chance in this research.   July 2013.

4. Dementia Risk Doubled in Patients Following Stroke September 2018 

The latest here:

FDA grants 510(k) clearance for Alzheimer’s, dementia diagnosis software

The FDA has granted 510(k) clearance to German medical technology company AIRAmed for its medical image management and processing system designed to assist physicians in early detection of Alzheimer’s disease and other dementias.

According to a company press release, the AIRAscore system utilizes deep learning and artificial intelligence technology to provide quantitative assessment of brain volume with objectively verifiable data using standard MRI brain scans. The process can be completed in just 5 minutes.

The FDA has granted 510(k) clearance to AIRAmed for its AIRAscore brain volumetry software, which can help clinicians diagnose and distinguish between different forms of dementia and other neurological conditions. Image: Adobe Stock

In addition to reporting absolute values with accurate volumes of tissues and brain areas, standardized to an individual’s anatomy, the system compares these volumes with a large reference population, corrected for head size, age and sex. The data is presented in an easy-to-understand format, comparable to a blood laboratory report, the release stated.

“For so long, we’ve been limited to reading a patient’s MRI to detect Alzheimer’s and other dementias,” Tobias Lindig, MD, AIRAmed’s founder and managing director, said in the release. “However, we know from several studies that patients with these brain diseases suffer from subtle brain volume loss early in their disease course that cannot be observed with the human eye. With AIRAscore, we are now offering physicians a highly precise, quantitative tool for the rapid detection of areas with a brain volume below the normal range.”

The company further stated its technology aids in the differentiation of several dementia forms, including AD, frontotemporal dementia, movement disorders like atypical Parkinson syndromes and other conditions with known patterns of brain volume loss. Additionally, AIRAscore can provide auto segmentation of grey matter, white matter, cerebrospinal fluid and T1 hypointensities, along with detailed measurements of all brain lobes, midbrain and pons, hippocampus, cerebellum and ventricular systems.

The software, which has been used in Europe for 4 years, will be available for purchase in the United States in the first quarter of 2024, the release stated.

(Re)constructing identity following acquired brain injury:The complex journey of recovery after stroke

You blithering idiots wouldn't have to work on this secondary problem if you solved the primary problem of 100% recovery. Are you that fucking stupid you can't see the correct way forward?

 (Re)constructing identity following acquired brain injury:The complex journey of recovery after stroke

Elena Faccio MSc, Professor, Associate Professor in Clinical Psychology, Psychologist,Psychotherapist1|Cristina Fonte PhD, Psychologist, psychotherapist2|Nicola Smania Professor, physician2|Jessica Neri PhD, Researcher, Psychologist, Psychotherapist1

Abstract

 Introduction: 

 

People with post stroke acquired brain injury (ABI) face a complex and often troubled identity reconstruction journey. The literature is rich with studies related to the psychological and neuropsychological components involved in rehabilitation, but it is lacking with respect to the investigation of the existential dimensions and the challenges associated with finding new senses and meanings for one's identity and future perspectives, body and interpersonal relationships.Methods:The aim of this study is to investigate the narrative processes of identity reconstruction after brain damage. Through a qualitative approach, 30 autobiographical narratives about self, body and the relationships with others were collected and analyzed. Semistructured interviews were used for the data collection. Narrative and positioning analysis were applied. 

 

Results:

 

 Four main positionings emerged: sanctioning a radical break with one's previous life; assuming a sense of salvation and compulsory as well as irreversible adaptation to the limitations associated with one's condition; feeling different and disabled; and considering new possibilities and active constructions of self‐being in relationship with others. These results underline the narrative processes of construction of the injury and the identity and delineate possible resources and instruments to improve the clinical practice for health practitioners.  They are also valuable for other professionals who deal with neurological services and rehabilitation, such as psychological counselling and support for persons who have experienced ABI and their families.Patient or Public Contribution:This work resulted from a close collaboration between two universities and a hospital neurological rehabilitation department in the Veneto Region (Northern Italy). Three associations of people with stroke and their families living in the same area contributed to designing the research on the basis of the needs expressed by their members with the aim to identify strategies and devices to be implemented in the public service to improve the care pathway. They also participated in the interpretation of the data.

Package of interventions for rehabilitation: module 3: neurological conditions - WHO

 Is your doctor familiar with the stroke and dementia modules? And will they get you 100% recovered?

Package of interventions for rehabilitation: module 3: neurological conditions

Overview

The Package of interventions for rehabilitation outlines the most essential interventions for rehabilitation for 20 health conditions. For each of the interventions, information on the required assistive products, equipment and consumables, and workforce that is usually skilled to deliver these interventions is available. As such, the Package of interventions for rehabilitation presents an indispensable resource for countries when planning for and budgeting the integration of rehabilitation services into their health systems.

Module 3: Neurological conditions comprises specific packages of interventions for rehabilitation for:

• stroke
• Parkinson disease
• traumatic brain injury
• spinal cord injury
• cerebral palsy
• dementia

Modules

Module 1: Introduction

Module 2: Musculoskeletal conditions

Module 3: Neurological conditions

Module 4: Cardiopulmonary conditions

Module 5: Neurodevelopmental disorders

Module 6: Sensory conditions

Module 7: Malignant neoplasm

Module 8: Mental health conditions

Unravelling the Neurophysiology Behind Locating a Target for Reaching and Grasping: Where Is It and What Is It? British Bobath Tutors Association

Why would you want your therapists to train in something that should have been shitcanned since 2003?

Physiotherapy Based on the Bobath Concept for Adults with Post-Stroke Hemiplegia: A Review of Effectiveness Studies 2003 

The latest useless shit here:

 Unravelling the Neurophysiology Behind Locating a Target for Reaching and Grasping:   Where Is It and What Is It?  British Bobath Tutors Association

BBTA Tutors: Clare Fraser & Debbie Strang

Reaching and grasping a target, like a refreshing bottle of water when you are thirsty, might appear effortless, but beneath this seemingly simple action lies a complexity of neurophysiological systems working in perfect harmony. From visual processing to executive functions, memory, and motor learning, our brains orchestrate a coordinated symphony to locate and interact with objects in our environment.

At the forefront of this process is vision, which plays a crucial role in target localisation. The visual system comprises of two main pathways: the dorsal and ventral streams. The dorsal stream, responsible for "where" processing, extracts information about spatial location and motion. When we spot the bottle of water on the table, this stream helps us determine its position relative to ourselves. Meanwhile, the ventral stream, responsible for "what" processing, identifies the object's identity and characteristics, such as size, predicted heaviness, slippage potential, and recognising it as a bottle of water.

Once the visual information is processed, pre-motor executive functions come into play. The frontal lobe, particularly the prefrontal cortex, is involved in planning and decision-making. It assesses the goal (quenching thirst) and strategizes how to achieve it (reaching for the water bottle). Working memory enables us to hold the plan in mind while executing it, maintaining the bottle's location in our mental space.

Motor preparation is a critical phase before the actual reach begins. The posterior parietal cortex integrates sensory information from the visual system and the somatosensory system, which receives feedback from our body's position and movement (see blog 4, linking this to Body Schema). This integration fine-tunes the motor plan and ensures the appropriate trajectory for the reach.

Motor learning is an essential aspect that enables us to refine our actions through experience. As we repeatedly reach for and grasp objects, our brains adjust and optimize the motor commands required for precision and efficiency, based on experience. The cerebellum and basal ganglia, key players in motor learning, help us to perfect these motor skills over time.

Finally, as the motor plan is finalized, the motor cortex sends the appropriate signals to the muscles in our arm and hand, initiating the reach and grasp movement. This movement comes on the background of postural stability and Anticipatory Postural Adaptations (see blogs 1-3, linking to postural control).

The brain continuously monitors our movement's progress and uses feedback to adjust if needed, ensuring accurate and smooth execution.

In conclusion, locating a target for reach and grasp, like a bottle of water, is a fascinating interplay of various neurophysiological systems. Vision and the dorsal and ventral streams help us perceive and identify the target, while pre-motor executive functions, memory, postural control, and motor learning lay the groundwork for an efficient movement.

By understanding the intricate workings of our brains in the reaching and grasping process, we gain insight into the components of human movement control that are core to the rehabilitation journey of our neurological patients. This enables us, as skilled therapists, to drive our patients recovery forwards, helping them to reach their personal goals.

We saw the impact of reaching and grasping functional improvements over 5 days, with the patients that we worked with at Walkergate Park Hospital in Newcastle, on the Advanced Bobath Course this year. It was so exciting (for all of us) to see the improvement in their arm and hand function, achieving new goals, moving forwards in their recovery.

Next time you reach for that bottle of water, consider whether you would like to know more about the neurophysiology relating to upper limb rehabilitation and sign up to a Bobath Course to take your knowledge and skills to the next level www.bbta.org.uk

Effect of Individualized Versus Standardized Blood Pressure Management During Endovascular Stroke Treatment on Clinical Outcome: A Randomized Clinical Trial

So still nothing on blood pressure management!

We've known of this problem for years! SOLVE IT BY CREATING BLOOD PRESSURE MANAGEMENT PROTOCOLS! Don't just tell us a problem exists, I'd fire anyone who doesn't solve the problem directly in front of them! No excuses!

• blood pressure management (68 posts to June 2017)

 

Effect of Individualized Versus Standardized Blood Pressure Management During Endovascular Stroke Treatment on Clinical Outcome: A Randomized Clinical Trial

Min Chen,

Jan Meis,

Arne Potreck,

Lukas D. Sauer,

Meinhard Kieser,

Martin Bendszus,

Wolfgang Wick,

Peter A. Ringleb,

Markus A. Möhlenbruch and

Silvia Schönenberger

Originally published21 Sep 2023https://doi.org/10.1161/STROKEAHA.123.044062Stroke. 2023;0

Abstract

Background:

Optimal blood pressure (BP) management during endovascular stroke treatment is not well established. We studied whether an individualized approach for managing BP during endovascular stroke treatment gives a better clinical outcome than an approach with standardized systolic BP targets.

Methods:

The INDIVIDUATE study (Individualized Blood Pressure Management During Endovascular Treatment of Acute Ischemic Stroke Under Procedural Sedation) is a randomized clinical trial with a prospective randomized open blinded end-point (PROBE) design. Patients were recruited between October 1, 2020 and July 7, 2022 at a single center at a tertiary care university hospital. Patients were eligible, when they were suffering from acute ischemic stroke of the anterior circulation with occlusions of the internal carotid artery and middle cerebral artery and a National Institutes of Health Stroke Scale score of ≥8 receiving endovascular stroke treatment in procedural sedation. The intervention consists of an individualized BP management strategy, where preinterventional baseline systolic BP (SBP) values are used as intraprocedural BP targets. As a control, the standard treatment aims to maintain the intraprocedural SBP between 140 and 180 mm Hg. The main prespecified outcome is the proportion of favorable functional outcomes 90 days after stroke, defined as a modified Rankin Scale score of 0 to 2.

Results:

Two hundred fifty patients were enrolled and included in the analysis, mean (SD) age was 77 (12) years, 142 (57%) patients were women, and mean (SD) National Institutes of Health Stroke Scale score on admission was 17 (5.2). In all, 123 (49%) patients were treated with individualized and 127 (51%) with standard BP management. Mean (SD) intraprocedural SBP was similar in the individualized versus standard BP management group (157 [19] versus 154 [18] mm Hg; P=0.16). The rate of favorable functional outcome after 3 months was not significantly different between the individualized versus the standard BP management group (25% versus 24%; adjusted odds ratio, 0.81 [95% CI, 0.41–1.61]; P=0.56).

Conclusions:

Among patients treated with endovascular stroke treatment due to an acute ischemic stroke of the anterior circulation, no significant difference was seen between the individualized BP management strategy, where intraprocedural SBP was targeted to baseline values, and the standardized regimen of targeting SBP between 140 and 180 mm Hg.

REGISTRATION:

URL: https://www.clinicaltrials.gov; Unique identifier: NCT04578288.

• Download figure
• Download PowerPoint

Imaging and clinical predictors of acute constipation in patients with acute ischemic stroke

 You've known for years that constipation follows stroke. WHERE IS THE PROTOCOL TO PREVENT CONSTIPATION? 

The incidence of constipation for stroke was 48%. 

Do you prefer your doctor and hospital incompetence NOT KNOWING OR NOT DOING anything on this?

Imaging and clinical predictors of acute constipation in patients with acute ischemic stroke

I Joon Han¹ Ji-Eun Lee² Ha-Na Song² In-Young Baek² Jongun Choi^2,3 Jong-Won Chung^2† Oh Young Bang^2† Gyeong-Moon Kim^2† Woo-Keun Seo^2,3*†

• ¹Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
• ²Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
• ³Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea

Background: Constipation symptoms are highly prevalent in acute ischemic stroke, but the clinical and neuroimaging predictors are unknown. This study aimed to identify lesions and clinical features associated with acute constipation.

Methods: Data from patients with acute ischemic stroke registered in a hospital-based stroke registry between January 2018 and December 2019 were analyzed. Clinical, laboratory, and imaging features were examined for associations with acute constipation. Using the topographic lesion on diffusion-weighted images, multivariate support vector regression-based lesion-symptom mapping (SVR-LSM) was conducted and compared between the non-constipation and acute constipation groups.

Results: A total of 256 patients (mean age 67 years, men: 64%) were included. Acute constipation was noted in 81 patients (32%). Initial stroke severity, represented by initial National Institutes of Health and Stroke Scale (NIHSS) scores, was associated with acute constipation. Laboratory parameters, including fibrin degradation products (FDP), fibrinogen, D-dimer, lipoprotein (a), and free fatty acid levels, also showed statistically significant differences between the non-constipation and constipation groups. FDP, D-dimer, and free fatty acid levels were independently associated with acute constipation in the logistic regression model after adjusting for initial NIHSS scores and potassium levels. SVR-LSM revealed that bilateral lesions in the precentral gyrus, insula, opercular part of the inferior frontal gyrus, the inferior parietal lobule, and lesions in the right middle frontal gyrus were significantly associated with acute constipation. The results were consistent after controlling for the initial NIHSS scores and poststroke potassium levels. When cardioembolic stroke subjects were excluded, the right insular and prefrontal cortex lesions lost their association with acute constipation.

Conclusion: Acute constipation symptoms after acute ischemic stroke are mainly related to bilateral lesions in the insula, precentral gyrus, postcentral gyrus, and inferior parietal lobule. Clinically important predictors of acute constipation include initial neurological severity and thromboembolic markers of stroke.

The predictive performance of artificial intelligence on the outcome of stroke: a systematic review and meta-analysis

 

Ohhh! A shiny new thing, but still just predicting failure to recover. Great distraction though! Useless!

The predictive performance of artificial intelligence on the outcome of stroke: a systematic review and meta-analysis

Yujia Yang¹ Li Tang¹ Yiting Deng¹ Xuzi Li¹ Anling Luo¹ Zhao Zhang¹ Li He¹ Cairong Zhu^2* Muke Zhou^1*

• ¹Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
• ²Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China

Objectives: This study aimed to assess the accuracy of artificial intelligence (AI) models in predicting the prognosis of stroke.

Methods: We searched PubMed, Embase, and Web of Science databases to identify studies using AI for acute stroke prognosis prediction from the database inception to February 2023. Selected studies were designed cohorts and had complete data. We used the Quality Assessment of Diagnostic Accuracy Studies tool to assess the qualities and bias of included studies and used a random-effects model to summarize and analyze the data. We used the area under curve (AUC) as an indicator of the predictive accuracy of AI models.

Results: We retrieved a total of 1,241 publications and finally included seven studies. There was a low risk of bias and no significant heterogeneity in the final seven studies. The total pooled AUC under the fixed-effects model was 0.872 with a 95% CI of (0.862–0.881). The DL subgroup showed its AUC of 0.888 (95%CI 0.872–0.904). The LR subgroup showed its AUC 0.852 (95%CI 0.835–0.869). The RF subgroup showed its AUC 0.863 (95%CI 0.845–0.882). The SVM subgroup showed its AUC 0.905 (95%CI 0.857–0.952). The Xgboost subgroup showed its AUC 0.905 (95%CI 0.805–1.000).

Conclusion: The accuracy of AI models in predicting the outcomes of ischemic stroke is good from our study. It could be an assisting tool for physicians in judging the outcomes of stroke patients. With the update of AI algorithms and the use of big data, further AI predictive models will perform better.

Predictors of failure of early neurological improvement in early time window following endovascular thrombectomy: a multi-center study

 

What fucking stupidity! All you are doing is predicting failure to recover! Survivors want recovery. Create protocols that will do that! Useless.

Predictors of failure of early neurological improvement in early time window following endovascular thrombectomy: a multi-center study

Yuzheng Lai¹ Francesco Diana² Mohammad Mofatteh³ Thanh N. Nguyen⁴ Eric Jou⁵ Sijie Zhou⁶ Hao Sun¹ Jianfeng He¹ Wenshan Yan¹ Yiying Chen¹ Mingzhu Feng⁷ Junbin Chen⁸ Jicai Ma⁸ Xinyuan Li⁹ Heng Meng^10* Mohamad Abdalkader^4* Yimin Chen^7,11*

• ¹Department of Neurology, Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine (Nanhai District Hospital of Traditional Chinese Medicine of Foshan City), Foshan, China
• ²Department of Neuroradiology, A.O.U. San Giovanni di Dio e Ruggi d’Aragona, University of Salerno, Salerno, Italy
• ³School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
• ⁴Department of Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
• ⁵School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
• ⁶Department of Surgery of Cerebrovascular Diseases, First People’s Hospital of Foshan, Foshan, China
• ⁷Department of Neurology and Advanced National Stroke Center, Foshan Sanshui District People’s Hospital, Foshan, China
• ⁸Department of Neurology, The Affiliated Yuebei People’s Hospital of Shantou University Medical College, Shaoguan, China
• ⁹The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
• ¹⁰Department of Neurology, The First Affiliated Hospital of Jinan University, Clinical Neuroscience Institute of Jinan University, Guangzhou, China
• ¹¹Neuro International Collaboration (NIC), Foshan, China

Background and objective: Endovascular thrombectomy (EVT) has become the gold standard in the treatment of acute stroke patients. However, not all patients respond well to this treatment despite successful attempts. In this study, we aimed to identify variables associated with the failure of improvements following EVT.

Methods: We retrospectively analyzed prospectively collected data of 292 ischemic stroke patients with large vessel occlusion who underwent EVT at three academic stroke centers in China from January 2019 to February 2022. All patients were above 18 years old and had symptoms onset ≤6 h. A decrease of more than 4 points on the National Institute of Health Stroke Scale (NIHSS) after 24 h compared with admission or an NIHSS of 0 or 1 after 24 h was defined as early neurological improvement (ENI), whereas a lack of such improvement in the NIHSS was defined as a failure of early neurological improvement (FENI). A favorable outcome was defined as a modified Rankin scale (mRS) score of 0–2 after 90 days.

Results: A total of 183 patients were included in the final analyses, 126 of whom had FENI, while 57 had ENI. Favorable outcomes occurred in 80.7% of patients in the ENI group, in contrast to only 22.2% in the FENI group (p < 0.001). Mortality was 7.0% in the ENI group in comparison to 42.1% in the FENI group (p < 0.001). The multiple logistic regression model showed that diabetes mellitus [OR (95% CI), 2.985 (1.070–8.324), p = 0.037], pre-stroke mRS [OR (95% CI), 6.221 (1.421–27.248), p = 0.015], last known well to puncture time [OR (95% CI), 1.010 (1.003–1.016), p = 0.002], modified thrombolysis in cerebral infarction = 3 [OR (95% CI), 0.291 (0.122–0.692), p = 0.005], and number of mechanical thrombectomy passes [OR (95% CI), 1.582 (1.087–2.302), p = 0.017] were the predictors of FENI.

Conclusion: Diabetes mellitus history, pre-stroke mRS, longer last known well-to-puncture time, lack of modified thrombolysis in cerebral infarction = 3, and the number of mechanical thrombectomy passes are the predictors of FENI. Future large-scale studies are required to validate these findings.

Interpretable machine learning for prediction of clinical outcomes in acute ischemic stroke

Nothing here gets survivors recovered. I'd have you all fired!

Interpretable machine learning for prediction of clinical outcomes in acute ischemic stroke

Joonwon Lee^† Kang Min Park^† Seongho Park^*†

• Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea

Background and aims: Predicting the prognosis of acute ischemic stroke (AIS) is crucial in a clinical setting for establishing suitable treatment plans. This study aimed to develop and validate a machine learning (ML) model that predicts the functional outcome of AIS patients and provides interpretable insights.

Methods: We included AIS patients from a multicenter stroke registry in this prognostic study. ML-based methods were utilized to predict 3-month functional outcomes, which were categorized as either favorable [modified Rankin Scale (mRS) ≤ 2] or unfavorable (mRS ≥ 3). The SHapley Additive exPlanations (SHAP) method was employed to identify significant features and interpret their contributions to the predictions of the model.

Results: The dataset comprised a derivation set of 3,687 patients and two external validation sets totaling 250 and 110 patients each. Among them, the number of unfavorable outcomes was 1,123 (30.4%) in the derivation set, and 93 (37.2%) and 32 (29.1%) in external sets A and B, respectively. Among the ML models used, the eXtreme Gradient Boosting model demonstrated the best performance. It achieved an area under the receiver operating characteristic curve (AUC-ROC) of 0.790 (95% CI: 0.775–0.806) on the internal test set and 0.791 (95% CI: 0.733–0.848) and 0.873 (95% CI: 0.798–0.948) on the two external test sets, respectively. The key features for predicting functional outcomes were the initial NIHSS, early neurologic deterioration (END), age, and white blood cell count. The END displayed noticeable interactions with several other features.

Conclusion: ML algorithms demonstrated proficient prediction for the 3-month functional outcome in AIS patients. With the aid of the SHAP method, we can attain an in-depth understanding of how critical features contribute to model predictions and how changes in these features influence such predictions.

Aspiration thrombectomy with the Penumbra System for patients with stroke and late onset to treatment: a subset analysis of the COMPLETE registry

Contrary to their bleating this was obviously a failure since no mention is made of 100% recovery. I don't accept their tyranny of low expectations that recanalization is the end goal of survivors; 100% recovery is the only goal in stroke! Why aren't you measuring that?

Aspiration thrombectomy with the Penumbra System for patients with stroke and late onset to treatment: a subset analysis of the COMPLETE registry

Ameer E. Hassan^1* Johanna T. Fifi² Osama O. Zaidat³

• ¹Department of Neurology, University of Texas Rio Grande Valley, Valley Baptist Medical Center, Harlingen, TX, United States
• ²Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
• ³Department of Endovascular Neurosurgery, Mercy Health St. Vincent Medical Center, Toledo, OH, United States

Background: The purpose of this study was to report the safety and performance of aspiration thrombectomy with the Penumbra System for patients with acute ischemic stroke (AIS) due to anterior circulation large vessel occlusion (LVO) and late onset to treatment.

Methods: This is a retrospective subset analysis of a global prospective multicenter registry (COMPLETE) that enrolled adults with AIS due to LVO and a pre-stroke modified Rankin Scale score (mRS) of 0 or 1 who were treated first-line with aspiration thrombectomy either alone (A Direct Aspiration First Pass Technique [ADAPT]) or in combination with the 3D Revascularization Device (ADAPT + 3D). This subset analysis included all patients in the registry who had anterior circulation LVO, an Alberta Stroke Program Early CT Score of at least 6, and late onset to treatment (>6 h from stroke onset to puncture).

Results: Of the 650 patients in the COMPLETE registry, 167 were included in this subset analysis. The rate of successful revascularization (Since you don't mention 100% recovery, the only conclusion possible is complete failure!)(modified thrombolysis in cerebral infarction score 2b-3 achieved) at the end of the procedure was 83.2%, the rate of good functional outcome (mRS 0–2) at 90 days was 55.4%, and the all-cause mortality rate at 90 days was 14.4%. No device-related serious adverse events (SAEs) occurred. Procedure-related SAEs occurred in 9 patients (5.4%) within 24 h and in 12 patients (7.2%) overall. The rate of successful revascularization was higher for patients treated first-line with ADAPT (88.0%) than for patients treated first-line with ADAPT + 3D (75.0%; p = 0.035); no significant difference was observed between the ADAPT and ADAPT + 3D groups for any other primary or secondary outcome.

Conclusion: For patients with AIS due to anterior circulation LVO and with late onset to treatment, aspiration thrombectomy with the Penumbra System appears to be safe and effective. (Nope, nope, nope!) The rates of good functional outcome and all-cause mortality from this study compared favorably with those rates from the medical management arms of the DAWN and DEFUSE-3 studies.

Clinical trial registration: https://www.clinicaltrials.gov, NCT03464565.

Elevated white blood cell counts in ischemic stroke patients are associated with increased mortality and new vascular events

Well you described something but provided no solutions to prevent or alleviate the problem. SO ABSOLUTELY FUCKING USELESS! YOU'RE FIRED!

Elevated white blood cell counts in ischemic stroke patients are associated with increased mortality and new vascular events

Thao Phuong Vo^1* Marie Hvelplund Kristiansen¹ Hans Carl Hasselbalch² Troels Wienecke¹

• ¹Neurology Department, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark
• ²Hematology Department, Zealand University Hospital, University of Copenhagen, Roskilde, Denmark

Background and purpose: High levels of white blood cells (WBC) in ischemic stroke have been shown to increase the risk of new vascular events and mortality in short and intermediate follow-up studies, but long-term effects remain unknown. We studied whether elevated levels of WBC in ischemic stroke patients are associated with new vascular events and mortality in a 10-year follow-up period.

Methods: We included ischemic stroke patients hospitalized between 2011 and 2012, categorizing their WBC counts within 48 h of stroke onset as high or normal (3.5–8.8 × 10⁹ mmol/L; >8.8 × 10⁹ mmol/L). Using Aahlen Johansen and Cox proportional hazard models with competing risk, we analyzed the association between WBC levels and new vascular events. Kaplan–Meier and standard Cox proportional hazard models were used to assess the risk of all-cause mortality.

Results: Among 395 patients (median age 69, [IQR: 63, 78], female patients 38,0%), 38.5% had elevated WBC at admission. During the 10-year follow-up, 113 vascular events occurred, with 46% in patients with elevated WBC and 54% in patients with normal WBC. After adjusting for relevant factors, elevated WBC levels were independently associated with increased risk of new vascular events (HR: 1.61, CI: 1.09–2.39 p < 0.05) and death (HR: 1.55, CI: 1.15–2.09, p < 0.05).

Conclusion: Elevated WBC levels in ischemic stroke patients are linked to a higher risk of new vascular events and mortality. Thus, ischemic stroke patients with elevated WBC without clinical infection need special attention to investigate possible underlying conditions to prevent future vascular events and reduce mortality. The interpretation of our results is limited by the absence of adjustment to premorbid functional status, stroke severity, and stroke treatment.