Five recent randomized controlled trials provided clear evidence that endovascular thrombectomy (EVT) improves outcomes after acute ischemic stroke caused by large vessel occlusions (LVOs), [1][2][3][4][5] and current guidelines recommend EVT in addition to intravenous thrombolysis (IVT) within 4.5 hours among patients with anterior circulation strokes and LVO. 6,7 Patients eligible for IVT should receive it without delay even if EVT is being considered, but the particular benefit of IVT is not yet well established. Moreover, in the real world, a significant proportion of acute ischemic stroke patients receive IVT at local stroke centers where EVT is not available. Such centers apply a drip and ship protocol when an EVT candidate is identified, with the necessary subsequent transfer causing a delayed puncture. In this context, building up evidence of the specific role of IVT when added to EVT among LVO patients is necessary to reorganize stroke systems of care accordingly. We compared direct EVT (dEVT) against combined IVT+EVT in patients with anterior circulation strokes caused by LVO. MethodsWe used data included in the SONIIA registry (Sistema Online d'Informació de l'Ictus Agut), a government-mandated, populationbased, externally audited, prospective database that includes all acute ischemic stroke patients treated with reperfusion therapies in the region Background and Purpose-Whether intravenous thrombolysis adds a further benefit when given before endovascular thrombectomy (EVT) is unknown. Furthermore, intravenous thrombolysis delays time to groin puncture, mainly among drip and ship patients. Methods-Using region-wide registry data, we selected cases that received direct EVT or combined intravenous thrombolysis+EVT for anterior circulation strokes between January 2011 and October 2015. Treatment effect was estimated by stratification on a propensity score. The average odds ratios for the association of treatment with good outcome and death at 3 months and symptomatic bleedings at 24 hours were calculated with the Mantel-Haenszel test statistic. Results-We included 599 direct EVT patients and 567 patients with combined treatment. Stratification through propensity score achieved balance of baseline characteristics across treatment groups. There was no association between treatment modality and good outcome (odds ratio, 0.97; 95% confidence interval, 0.74-1.27), death (odds ratio, 1.07; 95% confidence interval, 0.74-1.54), or symptomatic bleedings (odds ratio, 0.56; 95% confidence interval, 0.25-1.27). of Catalonia from January 2011. Further details of this registry have been published elsewhere. 8 Briefly, the database includes relevant baseline information (prestroke medical history, medications and functional status, time of stroke onset and hospital arrival, severity, time of neuro/ vascular imaging, IVT and groin puncture time, and complications) and the neurological situation at 24 to 36 hours post-treatment, including symptomatic bleedings. Outcome variables at 3 months are good outcome (modif...

This study reinforces the role of revascularization and time to treatment to achieve enhanced functional outcomes and identifies other clinical features that independently predict good/fatal outcome after endovascular treatment/therapy.

Evidence for adverse effects of volatile anaesthetics on exposed personnel is scarce and inconsistent, but there is no evidence of adverse effects when environmental levels are kept within legal threshold values. Further studies are needed to improve our knowledge of the effects of occupational exposure to volatile anaesthetics. New surveillance methods that include systematic data collection, clinical signs and biomarkers of exposure are required to formulate consistent and reproducible surveillance criteria for exposed personnel.

The stress effect on multiple sclerosis remains unclear. Moderating psychosocial factors may be involved. This study compares some of them in people with multiple sclerosis and healthy controls, and their association with disease parameters. Coping style, social support, anxiety, alexithymia and early-life stress were measured, along with impairment and functionality. People with multiple sclerosis scored significantly higher on anxiety, alexithymia, and avoidance and instinctive coping but lower in social support. No differences were found in earlylife stress. Impairment was related to avoidance, and functionality to avoidance and anxiety. Psychotherapeutic approaches focused on these psychosocial factors may improve functionality, impairment and quality of life in people with multiple sclerosis. 1" " Briones*Buixassa,"L.,"Milà,"R.,"Arrufat,"F."X.,"Aragonès,"J."M,"Bufill,"E.,"Luminet,"O.,"&"Moss* 1" Morris,"R."(in"press)."A case-control study of psychosocial factors which may predict or 2" moderate the effect of stress in multiple sclerosis. Journal of Health Psychology." 3" 4"2" " 5" Abstract 6" 7"The stress effect on Multiple Sclerosis (MS) remains unclear. Moderating 8"psychosocial factors may be involved. This study compares some of them in people 9"with MS (pwMS) and healthy controls, and their association with disease parameters. 10"Coping style, social support, anxiety, alexithymia and early-life stress were measured, 11"along with impairment and functionality. PwMS scored significantly higher on anxiety, 12"alexithymia, and avoidance and instinctive coping but lower in social support. No 13" differences were found in early-life stress. Impairment was related to avoidance, and 14" functionality to avoidance and anxiety. Psychotherapeutic approaches focused on these 15"psychosocial factors may improve functionality, impairment, and quality of life in 16"pwMS. 17" 18"19"

Objective: To determine the age-specific incidence and clinical-epidemiological characteristics of an Amyotrophic lateral sclerosis (ALS) cohort patient in Catalonia (Spain). Methods and results: New cases diagnosed between January 1, 2004 and December 31, 2013 were 41 (20 men and 21 women), with an annual crude incidence rate of 2.7 per 100,000 person-years (95% CI 1.90 -3.59). The incidence rate increased with age reaching a peak in the age-group of 70 to 79 years. There was a non significant decrease in the incidence rate in the group of patients over 80 (P value = 0.75) 17.99 per 100 000 person years (95% CI 7.81 -28.17). The percentage of patients over age 80 was 29.3% and over age 85 was 9.8%. The prevalence rate at the end of the study period was 8.38/100.000 of the total population. Mean age at symptom onset was 76.0 years. Onset of symptoms was bulbar or generalized in 36.6% of cases.Conclusions: ALS incidence in Osona is within the range of other countries across Europe. Our results suggest that the age-specific incidence rate of ALS increases with age through the oldest age groups suggesting an age-risk effect to develop the disease.