Background and Objectives: Pretreatment with intravenous thrombolysis (IVT) is still recommended in all eligible acute ischemic stroke patients with large-vessel occlusion before mechanical thrombectomy (MTE). However, the added value and safety of bridging therapy versus direct MTE remains controversial. We aimed at evaluating the influence of r-tPA dose level in patients with middle cerebral artery (MCA) occlusion treated with MTE. Materials and Methods: We prospectively compared clinical and radiological outcomes in 38 bridging patients, with 65 receiving direct MTE for MCA stroke admitted to Vilnius University Hospital Santaros Clinics. Following our protocol, r-tPA infusion was stopped just before MTE in the operating room. Therefore, we divided all bridging patients into three groups according to the amount of r-tPA they received: bolus, partial dose or full dose. Functional independence at 90 days was assessed by a modified Rankin Scale score, i.e., from 0–2. The safety outcomes included 90-day mortality and any intracerebral hemorrhage (ICH). Results: Baseline characteristics and functional outcome at 90 days did not differ between the bridging and direct MTE groups. Shorter MTE procedure and hospitalization time (p = 0.025 and p = 0.036, respectively) were observed in the direct MTE group. An IVT treatment subgroup analysis showed higher rates of symptomatic ICH (p < 0.001) and longer intervals between imaging to MTE (p = 0.005) in the full r-tPA dose group. Conclusions: In patients with an MCA stroke, direct MTE seems to be a safe and equally effective as bridging therapy. The optimal r-tPA dose remains unclear. Randomized trials are needed to accurately evaluate the added value of r-tPA in patients treated with MTE.

Osteoarthritis (OA) is a leading cause of disability worldwide, with its prevalence rising due to aging populations. Management ranges from conservative treatments such as weight management and pharmacologic therapy to surgical interventions such as total joint replacement. However, treating moderate knee OA remains challenging for patients unresponsive to conservative care but not yet surgical candidates. Genicular artery embolization (GAE) has emerged as a minimally invasive procedure targeting abnormal angiogenesis and inflammation in OA. This article explores GAE’s mechanism, patient-selection criteria, and effectiveness in pain reduction and functional improvement. Studies suggest that GAE has the potential to significantly improve pain and function in mild to moderate OA, with sustained benefits. Patient selection is crucial for optimal outcomes, with imaging playing a key role. While conventional MRI assesses structural damage, Dynamic Contrast-Enhanced MRI (DCE-MRI) offers superior insights by evaluating synovitis, quantifying cartilage degradation, and monitoring treatment response. Due to its strong correlation with pain scores and status as the best surrogate marker for inflammation in synovitis, DCE-MRI holds significant potential to enhance patient selection and treatment monitoring for GAE.

The aim of the study was to evaluate the diagnostic utility of specific miRNAs in the preoperative assessment of thyroid nodules. One hundred and sixty thyroid fine needle aspiration biopsy (FNAB) samples with suspected thyroid carcinoma were collected. To detect the levels of miRNA expression in FNAB, next generation small RNA sequencing was performed in 60 samples. Based on the results obtained, three miRNAs (miR125A, miR200B, miR4324) were selected for further analysis. Based on the most frequently reported miRNAs in the literature associated with thyroid papillary carcinoma (PTC), two more miRNA (miR146B, miR221) were selected for further validation, using real-time reverse transcriptase polymerase chain reaction (RT-PCR) in 36 benign and 64 PTC samples. Expression of miR125A, miR146B, miR221, and miR4324 was significantly higher in patients with PTC compared with benign thyroid nodules (p ˂ 0.05). miR125A and miR4324 were also significantly more highly expressed in patients with extrathyroidal tumor extension compared to those without extrathyroidal PTC extension (p < 0.001). We also found a significantly higher expression of miR221 (p = 0.043) in patients with multifocal carcinomas compared to patients with single foci carcinomas. This prospective study showed that the expression analysis of four miRNAs (miR125A, miR146B, miR221, and miR4324) improve accuracy of FNAB, which could allow a better pre-operative diagnostic and prognostic assessment of thyroid malignancies.

Background. Constantly evolving guidelines for the treatment of ischemic stroke in light of widely published clinical trials show no final consensus; many factors that may significantly alter treatment outcomes are still under investigation. Each stroke center treats patients with ischemic stroke due to major artery occlusion differently depending on available resources, expert judgment, and clinical experience. The aim of this study was to evaluate the influence of periprocedural factors (intravenous thrombolysis, balloon-occlusive catheter use, number and timing of thrombectomy sessions, and type of anesthesia) on recanalization success and good clinical outcomes.Materials and methods. We included 191 patients who were treated with mechanical thrombectomy (MTE) due to large vessel occlusion in the anterior circulation from January 2015 to November 2018 in Vilnius University Hospital Santaros Clinics. Demographic, work organization, and clinical variables were evaluated. The primary outcome was functional independence after 90 days (modified Rankin scale 0-2). Secondary outcomes were successful reperfusion (TICI 2b-3) and change in neurological status by NIHSS at 2 and 24 hours.Results. No significant difference in outcomes was found between MTE groups of direct and combined therapy, the balloon-occlusive catheter use or the type of applied anesthesia. MTE procedure time is related to the recanalization success and good clinical outcome (p<0.0001): in the case of a successful MTE procedure the duration of MTE was almost half that of a failed MTE (mean 42.6 min. and 74.2 min., respectively). The probability of good clinical outcome decreases by 1.78-fold for patients over 70 years old (95% CI 0.999-3.274). Every 10-year increase in age was associated with a 1.32-fold decrease (95% CI 1.008-1.765) and every 30 min. increase in MTE procedure time with a 2.32-fold decrease in the probability of a good outcome at 90 days (95% CI 1.607-3.475). Each recanalization over 270 min. from symptom onset decreased the odds of a good outcome by 2.28-fold (95% CI 1.219-4.289).Conclusions. MTE procedure time was inversely proportional to the success of the procedure itself and good clinical outcome. Trends towards better clinical outcomes were observed in younger patients and in those who started treatment with MTE within 4.5 hours of onset of stroke symptoms. The added value of intravenous thrombolysis and balloon-occlusive catheter use for the success of the MTE procedure and good clinical outcomes was not established.