INTRODUCTION: Acute symptomatic occlusion of the internal carotid artery (ICA) is associated with unfavorable prognosis. However, no clear definition of its optimal treatment exists. The aim of this study was to evaluate the efficacy and risks of urgent carotid endarterectomy (CEA) in patients with ischemic stroke due to acute extracranial ICA occlusion. METHODS: A retrospective analysis was performed of all consecutive patients undergoing urgent CEA for acute extracranial ICA occlusion during the period from July 2014 to June 2021. The primary outcome was functional independence at three months defined as modified Rankin Scale (mRS) score 2. Secondary outcomes included the severity of the neurological deficit at the time of discharge and its comparison with the preoperative condition as assessed using the National Institutes of Health Stroke Scale (NIHSS), the incidence of symptomatic intracerebral hemorrhage (ICH), and 30-day periprocedural mortality. RESULTS: During the study period, a total of 42 urgent CEAs were performed for acute extracranial ICA occlusions. The median preoperative NIHSS score was 7 (interquartile range [IQR] 5-13). The median time interval between the onset of symptoms and surgery was 290 minutes (IQR 235-340). Technical success rate of urgent CEA was 97.6% (41 patients). The median NIHSS at the time of hospital discharge was 2 (IQR 3-7; p.

• Keywords
• carotid endarterectomy, emergent, internal carotid artery, occlusion, stroke, urgent,
• MeSH
• Carotid Artery, Internal surgery   MeSH
• Time Factors MeSH
• Stroke * etiology   MeSH
• Ischemic Stroke * MeSH
• Endarterectomy, Carotid * adverse effects   MeSH
• Humans MeSH
• Retrospective Studies MeSH
• Carotid Stenosis * complications   surgery   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

OBJECTIVE: The clinical outcome of surgical extracranial internal carotid artery (eICA) recanalization may be adversely affected by intraoperative ischemia. Median nerve somatosensory evoked potential (SEP) amplitude correlates well with cerebral blood flow. Our study presents the value of intraoperative SEP and selective shunting in the prevention of intraoperative ischemia development during urgent eICA recanalization. METHODS: Prospective recruitment of patients with acute unilateral eICA occlusion. All underwent surgical recanalization with intraoperative monitoring of scalp median SEPs. Preoperative clinical findings, cerebral collaterals, and 3 month functional outcome were evaluated. RESULTS: The cohort consisted of 33 patients. Intraoperative SEP amplitude decreased significantly in 6 (18.2%). An intraluminal shunt was inserted twice (6.1%), surgical complications occurred in 6 (18.2%), intracerebral hemorrhage was not found. Favorable outcome 3 months after surgery according to the modified Rankin scale (mRS 0-2) was achieved in 28 (84.8%), 3 patients died (9.1%). CONCLUSIONS: Intraoperative SEP during urgent eICA recanalization seems to be beneficial. Thanks to the effective measure based on the intraoperative SEP changes, the clinical outcome in four(12.1%) could be positively affected. SIGNIFICANCE: The results suggest that selective shunting based on intraoperative median SEPs may prevent intraoperative ischemia and may improve overall outcome of urgent eICA recanalization.

• Keywords
• Intraoperative monitoring, Ischemic stroke, Selective shunting, Somatosensory evoked potentials, Urgent recanalization,
• MeSH
• Carotid Artery, Internal surgery   MeSH
• Intraoperative Neurophysiological Monitoring * MeSH
• Brain Ischemia * prevention & control   MeSH
• Humans MeSH
• Carotid Artery Diseases * surgery   MeSH
• Prospective Studies MeSH
• Evoked Potentials, Somatosensory physiology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

OBJECTIVES: The aim of this study is to propose an approach for developing trustworthy recommendations as part of urgent responses (1-2 week) in the clinical, public health, and health systems fields. STUDY DESIGN AND SETTING: We conducted a review of the literature, outlined a draft approach, refined the concept through iterative discussions, a workshop by the Grading of Recommendations Assessment, Development and Evaluation Rapid Guidelines project group, and obtained feedback from the larger Grading of Recommendations Assessment, Development and Evaluation working group. RESULTS: A request for developing recommendations within 2 week is the usual trigger for an urgent response. Although the approach builds on the general principles of trustworthy guideline development, we highlight the following steps: (1) assess the level of urgency; (2) assess feasibility; (3) set up the organizational logistics; (4) specify the question(s); (5) collect the information needed; (6) assess the adequacy of identified information; (7) develop the recommendations using one of the 4 potential approaches: adopt existing recommendations, adapt existing recommendations, develop new recommendations using existing adequate systematic review, or develop new recommendations using expert panel input; and (8) consider an updating plan. CONCLUSION: An urgent response for developing recommendations requires building a cohesive, skilled, and highly motivated multidisciplinary team with the necessary clinical, scientific, and methodological expertise; adapting to shifting needs; complying with the principles of transparency; and properly managing conflicts of interest.

• Keywords
• GRADE, Pandemic, Trustworthy guideline, Urgent recommendation,
• MeSH
• Outcome Assessment, Health Care methods   organization & administration   MeSH
• Information Management * methods   organization & administration   MeSH
• Consensus MeSH
• Humans MeSH
• Evidence-Based Medicine standards   trends   MeSH
• Practice Guidelines as Topic standards   MeSH
• Systematic Reviews as Topic MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

Pedal bypass (arterial reconstruction with distal anastomosis on the dorsal pedal artery (DPA) or in the submalleolar portion of the posterior tibial artery) is now considered as a standard method of revascularisation in critically ischaemic limb with obliteration of the crural arterial system. While a number of studies in large cohorts have proved the success of this method in saving limbs with chronic critical ischaemia, only few papers report the pedal bypass as an urgent intervention. In this study, the authors describe 3 cases where urgent pedal bypass saved the limb threatened by an acute ischaemia (Fig. 3, Ref. 12).

• MeSH
• Leg blood supply   MeSH
• Adult MeSH
• Ischemia etiology   surgery   MeSH
• Humans MeSH
• Foot blood supply   MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Vascular Surgical Procedures * methods   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Research Support, Non-U.S. Gov't MeSH

40 patients suffering from electrical injuries were rehabilitated using a new system of urgent conservative debridement and flap coverage in the period from October 1984 to July 1988. For this purpose, a 1-4 year follow-up was needed. Good appearance and functions of the extremities or organs were obtained and the amputation rate was lower (7.5%) than that used in patients treated with traditionally conservative methods (47.7% in the same hospital.

• MeSH
• Surgical Flaps methods   MeSH
• Child MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Electric Injuries surgery   MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Check Tag
• Child MeSH
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

BACKGROUND AND PURPOSE: International recommendations advocate that carotid endarterectomy (CEA) should be performed within 2 weeks from the index event in symptomatic carotid artery stenosis (sCAS) patients. However, there are controversial data regarding the safety of CEA performed during the first 2 days of ictus. The aim of this international, multicenter study was to prospectively evaluate the safety of urgent (0-2 days) in comparison to early (3-14 days) CEA in patients with sCAS. METHODS: Consecutive patients with non-disabling (modified Rankin Scale scores ≤2) acute ischaemic stroke or transient ischaemic attack due to sCAS (≥70%) underwent urgent or early CEA at five tertiary-care stroke centers during a 6-year period. The primary outcome events included stroke, myocardial infarction or death during the 30-day follow-up period. RESULTS: A total of 311 patients with sCAS underwent urgent (n = 63) or early (n = 248) CEA. The two groups did not differ in baseline characteristics with the exception of crescendo transient ischaemic attacks (21% in urgent vs. 7% in early CEA; P = 0.001). The 30-day rates of stroke did not differ (P = 0.333) between patients with urgent (7.9%; 95% confidence interval 3.1%-17.7%) and early (4.4%; 95% confidence interval 2.4%-7.9%) CEA. The mortality and myocardial infarction rates were similar between the two groups. The median length of hospitalization was shorter in urgent CEA [6 days (interquartile range 4-6) vs. 10 days (interquartile range 7-14); P < 0.001]. CONCLUSIONS: Our findings highlight that urgent CEA performed within 2 days from the index event is related to a non-significant increase in the risk of peri-procedural stroke. The safety of urgent CEA requires further evaluation in larger datasets.

• Keywords
• TIA, carotid, endarterectomy, safety, stroke, urgent,
• MeSH
• Time Factors MeSH
• Tertiary Care Centers MeSH
• Stroke etiology   surgery   MeSH
• Brain Ischemia etiology   surgery   MeSH
• Endarterectomy, Carotid adverse effects   MeSH
• Middle Aged MeSH
• Humans MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Carotid Stenosis complications   surgery   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH

PROBLEM: The present work was undertaken to investigate the occurence of autoantibodies to eight various phospholipids in time of urgent termination of the pregnancy (sectio caesarea) in patients in reproductive age with severe preeclamptic symptoms. METHOD OF STUDY: Autoantibodies against annexin V, ph-serine, ph-ethanolamine, ph-inositol, ph-DL-glycerol, cardiolipin, beta2-glycoprotein I (beta2-GPI), and phosphatidic acid were studied by ELISA methods. RESULTS: Increased levels of IgA-beta2-glycoprotein I, IgG-beta2-glycoprotein I, IgG- anti-ph-serine, and IgG-anticardiolipin were found in sera of preeclamptic women in the time of urgent sectio caesarea when compared to the control group with physiological pregnancy. CONCLUSION: Supposed increase in various antiphospholipid antibodies (aPLs) levels due to the stress during the short time of admission and a need for a quick medical decision to terminate the pregnancy was not unambiguously proven, but our results are evidently influenced by the current urgent life-saving treatment.

• MeSH
• Antibodies, Antiphospholipid blood   MeSH
• beta 2-Glycoprotein I immunology   MeSH
• Adult MeSH
• Enzyme-Linked Immunosorbent Assay MeSH
• Phosphoserine immunology   MeSH
• Humans MeSH
• Placental Circulation immunology   MeSH
• Abortion, Therapeutic MeSH
• Pre-Eclampsia blood   immunology   physiopathology   therapy   MeSH
• Pregnancy MeSH
• Thrombosis MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Names of Substances
• Antibodies, Antiphospholipid MeSH
• beta 2-Glycoprotein I MeSH
• Phosphoserine MeSH

OBJECTIVE: Changes in the N20/P25 amplitude of somatosensory evoked potentials (SEP) of the median nerve have been found to correlate with those in cortical regional cerebral blood flow (rCBF). Our study presents the use of median nerve SEP amplitude in predicting the clinical outcome of urgent surgical internal carotid artery (ICA) recanalization. METHODS: A total of 27 patients suffering an acute ischemic stroke (AIS) with extracranial ICA occlusion within 24 h were prospectively recruited. The primary preoperative endpoints included the SEP amplitude absolute value (SEP-amp) and the SEP amplitude side-to-side ratio (SEP-ratio). Clinical outcome at 3 months postoperatively was assessed using the modified Rankin scale (mRS-3M). RESULTS: The positive predictive values (PPVs) for SEP-amp and SEP-ratio were 95.5% and 100%, respectively, with the negative predictive values (NPVs) being 60.0% and 100%, respectively. The SEP-ratio correlated fully with mRS-3M. CONCLUSION: The median SEP side-to-side N20/P25 amplitude ratio seems to be a very strong positive and negative predictor of the clinical outcome of urgent recanalization of an extracranial ICA occlusion. SIGNIFICANCE: The results suggest that cortical evoked activity may help in selection patient for surgical recanalization and predict clinical recovery after an acute ischemic stroke.

• Keywords
• Amplitude ratio, Evoked neuronal activity, Ischemic stroke, Outcome prediction, Somatosensory evoked potentials, Urgent recanalization,
• MeSH
• Carotid Artery, Internal physiopathology   surgery   MeSH
• Ischemic Stroke diagnosis   surgery   MeSH
• Humans MeSH
• Postoperative Complications epidemiology   MeSH
• Prognosis MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Evoked Potentials, Somatosensory * MeSH
• Vascular Surgical Procedures adverse effects   methods   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

Despite decades of research on per- and polyfluoroalkyl substances (PFAS), fundamental obstacles remain to addressing worldwide contamination by these chemicals and their associated impacts on environmental quality and health. Here, we propose six urgent questions relevant to science, technology, and policy that must be tackled to address the "PFAS problem": (1) What are the global production volumes of PFAS, and where are PFAS used? (2) Where are the unknown PFAS hotspots in the environment? (3) How can we make measuring PFAS globally accessible? (4) How can we safely manage PFAS-containing waste? (5) How do we understand and describe the health effects of PFAS exposure? (6) Who pays the costs of PFAS contamination? The importance of each question and barriers to progress are briefly described, and several potential paths forward are proposed. Given the diversity of PFAS and their uses, the extreme persistence of most PFAS, the striking ongoing lack of fundamental information, and the inequity of the health and environmental impacts from PFAS contamination, there is a need for scientific and regulatory communities to work together, with cooperation from PFAS-related industries, to fill in critical data gaps and protect human health and the environment.

• Keywords
• PFAS, environment, equity, global, health, policy,
• MeSH
• Fluorocarbons * MeSH
• Humans MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH
• Research Support, N.I.H., Extramural MeSH
• Research Support, U.S. Gov't, Non-P.H.S. MeSH
• Names of Substances
• Fluorocarbons * MeSH

Extracranial-intracranial (EC-IC) bypass surgery is performed to allow flow augmentation in selected cases of occlusive cerebrovascular disease. The majority of EC-IC bypasses are described as an elective procedure in the prevention of hemodynamic ischemic stroke. There is only limited and controversial experience of superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis performed under urgent circumstances as a treatment of acute cerebral ischemia. We describe a unique case of a 75-year-old patient presenting with acute progressive hemodynamic ischemia after carotid endarterectomy (CEA), which developed contralaterally to the performed CEA in the region of chronic internal carotid artery (ICA) occlusion. Urgent performance of a standard STA-MCA bypass rapidly improved the cerebral hemodynamic and had an excellent therapeutic effect. The patient had recovered completely within 4 weeks of surgery. The role of urgent EC-IC bypass for stroke treatment is discussed.

• MeSH
• Middle Cerebral Artery surgery   MeSH
• Temporal Arteries surgery   MeSH
• Stroke therapy   MeSH
• Electroencephalography MeSH
• Brain Ischemia therapy   MeSH
• Endarterectomy, Carotid MeSH
• Humans MeSH
• Cerebral Angiography MeSH
• Cerebrovascular Circulation physiology   MeSH
• Neurosurgical Procedures methods   MeSH
• Tomography, X-Ray Computed MeSH
• Cerebral Revascularization MeSH
• Aged MeSH
• Evoked Potentials, Somatosensory MeSH
• Carotid Stenosis surgery   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH