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Background: Large-vessel occlusion (LVO) stroke represents one-third of acute ischemic stroke (AIS) in the United States but causes two-thirds of poststroke dependence and >90% of poststroke mortality. Prehospital LVO stroke detection permits efficient emergency medical systems (EMS) transport to an endovascular thrombectomy (EVT)-capable center. Our primary objective was to determine the feasibility of using a cranial accelerometry (CA) headset device for prehospital LVO stroke detection. Our secondary objective was development of an algorithm capable of distinguishing LVO stroke from other conditions., Methods: We prospectively enrolled consecutive adult patients suspected of acute stroke from 11 study hospitals in four different U.S. geographical regions over a 21-month period. Patients received device placement by prehospital EMS personnel. Headset data were matched with clinical data following informed consent. LVO stroke diagnosis was determined by medical chart review. The device was trained using device data and Los Angeles Motor Scale (LAMS) examination components. A binary threshold was selected for comparison of device performance to LAMS scores., Results: A total of 594 subjects were enrolled, including 183 subjects who received the second-generation device. Usable data were captured in 158 patients (86.3%). Study subjects were 53% female and 56% Black/African American, with median age 69 years. Twenty-six (16.4%) patients had LVO and 132 (83.6%) were not LVO (not-LVO AIS, 33; intracerebral hemorrhage, nine; stroke mimics, 90). COVID-19 testing and positivity rates (10.6%) were not different between groups. We found a sensitivity of 38.5% and specificity of 82.7% for LAMS ≥ 4 in detecting LVO stroke versus a sensitivity of 84.6% (p < 0.0015 for superiority) and specificity of 82.6% (p = 0.81 for superiority) for the device algorithm (CA + LAMS)., Conclusions: Obtaining adequate recordings with a CA headset is highly feasible in the prehospital environment. Use of the device algorithm incorporating both CA and LAMS data for LVO detection resulted in significantly higher sensitivity without reduced specificity when compared to the use of LAMS alone., (© 2024 The Authors. Academic Emergency Medicine published by Wiley Periodicals LLC on behalf of Society for Academic Emergency Medicine.)

The report of a bowel injury's occurring during Nd:YAG laser ablation of the endometrium without associated uterine perforation has raised the question of the safety of the procedure. The fibers used during the initial study on temperatures caused by Nd:YAG laser treatment of uterine tissue were placed directly in contact with the tissue. The results may not be applicable to a noncontact technique. Three patients underwent measurement of surface temperature of the uterus during ablation with the Nd:YAG laser using a noncontact technique. The temperatures were within acceptable ranges in two of the patients but reached potentially dangerous levels in the third. In vitro measurements of temperatures in uterine tissue obtained from fresh hysterectomy specimens were made using fine thermocouples. The temperature rise at 10 mm was greater per joule of delivered energy at 55 W than at 95. The temperature rise varied inversely with the tissue depth when the laser was applied in a continuous fashion with a noncontact technique. When the laser was applied continuously, the temperature rise at a depth of 8 mm was significantly greater than at 10 mm. Precise knowledge of the thickness of the uterine wall may be the limiting factor in determining the safety of the procedure.