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BACKGROUND: Endovascular thrombectomy (EVT) is standard of care for acute ischemic stroke. Stent assisted EVT with aspiration (SOLUMBRA) technique has remained a mainstay approach. There is growing evidence that A Direct Aspiration First Pass Technique (ADAPT) is a safe, efficient and effective approach for EVT, offering several advantages. This study describes and reports initial institutional experience in the use of a standardized scientific based aspiration only technique: CANADAPT. METHODS: Single center prospective cohort study was performed on consecutive patients treated for large/medium vessel ischemic stroke with CANADAPT. Intravenous thrombolytics were administered according to routine practice, independent of the decision to proceed with EVT. A sequential stepwise aspiration only technique was then applied, CANADAPT, consisting of three maneuvers, A, B and C. The reperfusion success rate, number of passes, use of rescue technique, complication rate and procedural cost were determined. RESULTS: Twenty-two patients were included in this case series representing M1 (17, 77%), M1/2 (2, 9%), carotid-T (2, 9%) and basilar (1, 5%) occlusions. First pass recanalization was achieved in 11 (50%) of patients. A further four patients had successful reperfusion with a second pass of CANADAPT (total 68% success rate). Only one patient had successful reperfusion with the aspiration catheter at the clot interface (CANADAPT A). All others required some withdrawal of the aspiration catheter for reperfusion (CANADAPT B and C). Seven patients had SOLUMBRA rescue. Of these, five patients (22% of total patients) had further successful reperfusion. Overall median procedural time was 23â min for first recanalization and 30â min for final recanalization. The cost per procedure was $6630 ± 1069 for CANADAPT, and $13,530 ± 2706 for SOLUMBRA techniques. CONCLUSIONS: CANADAPT represents a standardized scientific-based approach to aspiration only thrombectomy intervention. This initial study demonstrates the safety, efficiency and efficacy of this technique for use in EVT.
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RATIONAL AND OBJECTIVES: Despite the increasing use of point of care ultrasound (POCUS) across many specialities, ultrasound training in Canadian medical schools is limited. At our center, the student Radiology Interest Group (RIG) has addressed this learning need by hosting an annual workshop for diagnostic ultrasound to improve student competency in POCUS. MATERIALS AND METHODS: The Ultrasound Workshop is a voluntary event offered to second-year medical students by the RIG. Feedback from each session is collected to continually improve the workshop and inform on teaching strategies. This year, we also provided an online survey to all second-year medical students that compared the competency and confidence of students who did or did not attend the workshop. RESULTS: Student feedback from the Ultrasound Workshop was extremely positive. Students believed it was a valuable training experience and should be incorporated into the curriculum. The Ultrasound Workshop increased student's basic understanding of ultrasound but did not affect their confidence in using POCUS compared to students who did not attend. Finally, results from the online survey demonstrated that students believe learning POCUS is necessary for their future career, but there is not enough training in the current curriculum. CONCLUSION: The Ultrasound Workshop is a useful training exercise to increase student understanding of ultrasound, but more training may be required to increase student confidence and competency. Overall, extracurricular Ultrasound Workshops coordinated by student-led RIGs can serve as successful adjuncts to the curriculum.
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Educación de Pregrado en Medicina , Radiología , Estudiantes de Medicina , Canadá , Curriculum , Humanos , Opinión Pública , Radiología/educación , UltrasonografíaRESUMEN
In homeotherms, the hypothalamus controls thermoregulatory and adaptive mechanisms in energy balance, sleep-wake and locomotor activity to maintain optimal body temperature. Orexin neurons may be involved in these functions as they promote thermogenesis, food intake and behavioral arousal, and are sensitive to temperature and metabolic status. How thermal and energy balance signals are integrated in these neurons is unknown. Thus, we investigated the cellular mechanisms of thermosensing in orexin neurons and their response to a change in energy status using whole-cell patch clamp on rat brain slices. We found that warming induced an increase in miniature excitatory postsynaptic current (EPSC) frequency, which was blocked by the transient receptor potential vanilloid-1 (TRPV1) receptor antagonist AMG9810 and mimicked by its agonist capsaicin, suggesting that the synaptic effect is mediated by heat-sensitive TRPV1 channels. Furthermore, warming inhibits orexin neurons by activating ATP-sensitive potassium (KATP) channels, an effect regulated by uncoupling protein 2 (UCP2), as the UCP2 inhibitor genipin abolished this response. These properties are unique to orexin neurons in the lateral hypothalamus, as neighboring melanin-concentrating hormone neurons showed no response to warming within the physiological temperature range. Interestingly, in rats fed with western diet for 1 or 11weeks, orexin neurons had impaired synaptic and KATP response to warming. In summary, this study reveals several mechanisms underlying thermosensing in orexin neurons and their attenuation by western diet. Overeating induced by western diet may in part be due to impaired orexin thermosensing, as post-prandial thermogenesis may promote satiety and lethargy by inhibiting orexin neurons.