Endovascular Therapy vs Medical Management for Patients With Acute Stroke With Medium Vessel Occlusion in the Anterior Circulation

Importance Randomized clinical trials have shown the efficacy of endovascular therapy (EVT) for acute large vessel occlusion strokes. The benefit of EVT in acute stroke with distal, medium vessel occlusion (DMVO) remains unclear. Objective To examine the efficacy and safety outcomes associated with EVT in patients with primary DMVO stroke when compared with a control cohort treated with medical management (MM) alone. Design, Setting, and Participants This multicenter, retrospective cohort study pooled data from patients who had an acute stroke and a primary anterior circulation emergency DMVO, defined as any segment of the anterior cerebral artery (ACA) or distal middle cerebral artery, between January 1, 2015, and December 31, 2019. Those with a concomitant proximal occlusion were excluded. Outcomes were compared between the 2 treatment groups using propensity score methods. Data analysis was performed from March to June 2021. Exposures Patients were divided into EVT and MM groups. Main Outcomes and Measures Main efficacy outcomes included 3-month functional independence (modified Rankin Scale [mRS] scores, 0-2) and 3-month excellent outcome (mRS scores, 0-1). Safety outcomes included 3-month mortality and symptomatic intracranial hemorrhage. Results A total of 286 patients with DMVO were evaluated, including 156 treated with EVT (mean [SD] age, 66.7 [13.7] years; 90 men [57.6%]; median National Institute of Health Stroke Scale [NIHSS] score, 13.5 [IQR, 8.5-18.5]; intravenous tissue plasminogen activator [IV tPA] use, 75 [49.7%]; ACA involvement, 49 [31.4%]) and 130 treated with medical management (mean [SD] age, 69.8 [14.9] years; 62 men [47.7%]; median NIHSS score, 7.0 [IQR, 4.0-14.0], IV tPA use, 58 [44.6%]; ACA involvement, 31 [24.0%]). There was no difference in the unadjusted rate of 3-month functional independence in the EVT vs MM groups (151 [51.7%] vs 124 [50.0%]; P = .78), excellent outcome (151 [38.4%] vs 123 [31.7%]; P = .25), or mortality (139 [18.7%] vs 106 [11.3%]; P = .15). The rate of symptomatic intracranial hemorrhage was similar in the EVT vs MM groups (weighted: 4.0% vs 3.1%; P = .90). In inverse probability of treatment weighting propensity analyses, there was no significant difference between groups for functional independence (adjusted odds ratio [aOR], 1.36; 95% CI, 0.84-2.19; P = .20) or mortality (aOR, 1.24; 95% CI, 0.63-2.43; P = .53), whereas the EVT group had higher odds of an excellent outcome (mRS scores, 0-1) at 3 months (aOR, 1.71; 95% CI, 1.02-2.87; P = .04). Conclusions and Relevance The findings of this multicenter cohort study suggest that EVT may be considered for selected patients with ACA or distal middle cerebral artery strokes. Further larger randomized investigation regarding the risk-benefit ratio for DMVO treatment is indicated

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

An evaluation of flood inundation mapping from MODIS and ALOS satellites for Pakistan

The paper presents a moderate resolution imaging spectroradiometer (MODIS) time-series imagery-based algorithm for detection and mapping of seasonal and annual changes in flood extent, and tests this using the flooding of the Indus River Basin in 2010 – one of the greatest recent disasters that affected more than 25 million people in Pakistan. The algorithm was applied to produce inundation maps for 10 annual flood seasons over the period from 2000 to 2011. The MODIS flood products were validated in comparison with advanced land observing system (ALOS) sensors, which have both advanced visible and near infrared radiometer and phased array type L-band synthetic images using the flood fraction comparison method. A simple threshold method is created to cluster the data to identify the flood pixels in the imagery. Calculations are then made to estimate a flood area for each resolution. A statistical study is performed to analyze false positive and false negative rates using the ALOS sensors as ‘ground truth’. Comparison of two flood products at a grid size of 10 km resulted in the coefficient of determination range of 0.72–0.97. This research points to a relevant spatial resolution that could be effectively used to obtain accurate mapped products of the extent of the inundated area. The approach can be used to quantify the damage caused by floods

Managing shallow aquifers in the dry zone of Sri Lanka

This study looks at the groundwater issues in the dry zone of Sri Lanka and shows how the use of remote sensing with high-resolution images can help in groundwater management. A new approach is developed for automatic extraction of the location of agrowells using high-spatial-resolution satellite imageries. As an example, three pilot sites in three different aquifer systems in the country are considered, and their highresolution images are analyzed over two temporal time periods. The analysis suggests that the well density in all three regions has increased over the last few years, indicating higher levels of groundwater extraction. Using the well inventory developed by this new approach, the water budgeting was prepared for the mainland of Jaffna Peninsula. The analysis shows a wide variation in well density in the Jaffna Peninsula, ranging from (as little as) less than 15 wells per square kilometer to (as high as) more than 200 wells per square kilometer. Calculations made for the maximum allowable water extraction in each administrative division of Jaffna show that less than 3 h of daily extraction per well is possible in some districts. This points to an increasing pressure on groundwater resources in the region and thus highlights the importance of understanding groundwater budgets for sustainable development of the aquifers

Potential of satellite data in catastrophic flood risk mapping and assessment: case studies from Asia and Africa

Over last decades, we have witnessed an upward global trend in natural disaster occurrence. Hydrological and meteorological disasters are the main contributors to this pattern. In 2011, hydrological disaster, such as floods and wet mass movements, represented 52% of the overall disaster reported, causing 139.8 million victims and more than U.S. $70 billion in damages. Remote sensing from space plays an important role in flood mapping and flood risk assessment. Satellite images acquired in both optical and microwave range of electro-magnetic emissions are utilized for solving many problems related to flood risk management. This paper presents two different research activities (1) flood detection algorithm which uses vegetation and water indices (NDVI, EVI, LSWI, DVEL) at a spatial resolution of 500m and time period 2000 – 2013 using MODIS Terra/Aqua and JAXA PALSAR satellite to spatially and temporally quantify flood inundation extent at a continental scale in South Asia, Southeast Asia and Nigeria in the context of emergency response and (2) blending satellite data and RADAR (Rapid Agriculture Disaster Assessment Routine) tool for rapid flood damage assessment in agriculture with a case study in Sri Lanka. The results of the present study will provide valuable information to flood policy makers and flood disaster researchers