Quincy College

IntroductionIncomplete reperfusion following Mechanical Thrombectomy (MT) ranges from 12–34% and patients with Intracranial atherosclerotic (ICAS) occlusions are disproportionally affected.(1, 2)These patients are also more likely to experience poor functional outcomes. (3) Rescue stenting (RS) in these patients has shown promising rates of recanalization and better outcomes in preliminary studies. In our systemic review and meta‐analysis, we included Sixteen dual arm and seven single arm studies in order to study recanalization rate and compare outcomes following rescue stenting in patients with incomplete reperfusion compared to those managed conservatively (no‐RS).(4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19)(20, 21, 22, 23, 24, 25, 26)MethodsOur study was performed according to the preferred reporting items for systematic review and meta‐analysis (PRISMA) guidelines.(27) We incorporated studies that included participants, aged 18 years or older, and met the following criteria: (1) participants with ischemic stroke with Intracranial Atherosclerotic Stenosis (ICAS) who underwent at least one attempt of MT and had incomplete perfusion after the procedure (2) participants who received rescue stenting after MT with incomplete reperfusion, with no restrictions on the type of stents or stenting procedure used; (3) both observational studies (case series, cohort studies) and experimental designs (randomized controlled trials) were considered; (4) the control group consisted of patients incomplete reperfusion following MT but did not received no rescue stenting and were conservatively managed. We reported the recanalization rate in patients undergoing MT and compared the outcomes between the RS and no‐RS groups; MRS ≤ 2 at 90 days, Mortality at 90 days, Symptomatic Intra cranial Hemorrhage (sICH), Any Intracranial Hemorrhage (ICH), vessel dissection and vessel perforationResultsPatients who underwent stenting experienced recanalization rate of 84% (95% CI: 79.0 – 88.1). They also had significantly higher odds of a better functional outcome (MRS ≤ 2 at 90 days) at 3 months compared to the no‐RS group (OR 2.70 [95% CI: 1.89 ‐ 3.86]). Odds of sICH (OR 0.92 [95% CI: 0.62 ‐ 1.36]) and any ICH (OR: 0.64 [95% CI 0.40 ‐ 1.03]) were lower but insignificant in the RS group. Odds of mortality at 90 days were significantly lower in the RS group(OR 0.59 [95% CI: 0.42 ‐ 0.83]). No significant difference in Odds of Vessel dissection (OR 1.22 [95% CI: 0.19 ‐ 8.07]) or vessel perforation (OR 0.40 [ 95% CI: 0.10 ‐ 1.61]) between the two groups was noted.ConclusionOut meta‐analysis which included the most recent studies indicates that rescue setting after mechanical thrombectomy for large artery intracranial atherosclerosis with incomplete perfusion or with residual stenosis (>50 percent) is associated with better clinical outcomes and indicates lower mortality rate and associated complications. Therefore, rescue stenting can be considered as a safe and viable option in these patients.

The COVID-19 crisis has highlighted the role of remote learning in higher education. Increased investments and understanding of the transition to remote learning today will yield access to high-quality learning. Using data from an institution with a diverse student population, the purpose of this study was to explore students’ transition to remote learning during the COVID-19 pandemic by examining aspects within the course that contributed to perceptions of a high-quality remote learning experience. Five elements of the remote learning experience were statistically significant predictors of course quality ratings: ratings of the quality of student supports (Academic Advising, Tutoring, Internships, Financial Aid, etc.), ratings of connectedness to instructors in at least one class, the use of many learning activities by instructors, clear course organization by instructors, and clear communication used by instructors. Analysis of qualitative student interviews reinforced these findings and provided further support for the importance of reliable technology during remote learning.

Commentaries on viewpoint: Rejuvenation of the term sarcopenia

Psychological preparation of the child for surgery should be tailored to the developmental stage of the child, guided in part by the child’s age, and whether the child will be admitted to hospital after surgery or go home. Prehospital preparation for school-age children may include web-based strategies, videotapes, or a tour of the operating room. Younger children may benefit from a storybook or coloring book. Separation from the parents can be traumatic; anxiolysis should be addressed using distraction techniques including puppets, electronic games, and videos for the child, having the parents present at the induction or premedication, most commonly in the form of oral midazolam. Children with neurocognitive disorders present unique challenges, requiring parental presence and/or premedication for anxiolysis. Obtaining consent presents special concerns for the vulnerable child that requires a focused preoperative interview. Postoperative care should aim to reunite the parents with the child when the child is awake.