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Dougho Park,1,2 Hyoung Seop Kim,3 Jong Hun Kim4 1Medical Research Institute, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea; 2Department of Medical Science and Engineering, School of Convergence Science and Technology, Pohang University of Science and Technology, Pohang, Republic of Korea; 3Department of Physical Medicine and Rehabilitation, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea; 4Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of KoreaCorrespondence: Jong Hun Kim, Department of Neurology, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Goyang, 10444, Republic of Korea, Tel +82-31-900-0213, Fax +82-31-900-0343, Email jh7521@naver.comPurpose: Clinical studies on dysbiosis and stroke outcomes has been insufficient to establish clear evidence. This study aimed to investigate the effects of pre-antibiotic use before a stroke event on secondary outcomes using a longitudinal population-level database.Patients and Methods: This retrospective cohort study included adults aged 55 years or older diagnosed with acute ischemic stroke (AIS) and acute hemorrhagic stroke (AHS) between 2004 and 2007. Patients were followed-up until the end of 2019, and the target outcomes were secondary AIS, AHS, and all-cause mortality. Multivariable Cox regression analyses were applied, and we adjusted covariates such as age, sex, socioeconomic status, hypertension, diabetes, and dyslipidemia. Pre-antibiotic use was identified from 7 days to 1 year before the acute stroke event.Results: We included 159,181 patients with AIS (AIS group) and 49,077 patients with AHS (AHS group). Pre-antibiotic use significantly increased the risk of secondary AIS in the AIS group (adjusted hazard ratio [aHR], 1.03; 95% confidence interval [CI], 1.01– 1.05; p = 0.009) and secondary AHS in the AHS group (aHR, 1.08; 95% CI, 1.03– 1.12; p < 0.001). Furthermore, pre-antibiotic use in the AIS group was as

BACKGROUND AND OBJECTIVES: Benchmarks represent the best possible outcome and help to improve outcomes for surgical procedures. However, global thresholds mirroring an optimal and reachable outcome for microsurgical clipping of unruptured intracranial aneurysms (UIA) are not available. This study aimed to define standardized outcome benchmarks in patients who underwent clipping of UIA. METHODS: A total of 2245 microsurgically treated UIA from 15 centers were analyzed. Patients were categorized into low- ("benchmark") and high-risk ("nonbenchmark") patients based on known factors affecting outcome. The benchmark was defined as the 75th percentile of all centers' median scores for a given outcome. Benchmark outcomes included intraoperative (eg, duration of surgery, blood transfusion), postoperative (eg, reoperation, neurological status), and aneurysm-related factors (eg, aneurysm occlusion). Benchmark cutoffs for aneurysms of the anterior communicating/anterior cerebral artery, middle cerebral artery, and posterior communicating artery were determined separately. RESULTS: Of the 2245 cases, 852 (37.9%) patients formed the benchmark cohort. Most operations were performed for middle cerebral artery aneurysms (53.6%), followed by anterior communicating and anterior cerebral artery aneurysms (25.2%). Based on the results of the benchmark cohort, the following benchmark cutoffs were established: favorable neurological outcome (modified Rankin scale ≤2) ≥95.9%, postoperative complication rate ≤20.7%, length of postoperative stay ≤7.7 days, asymptomatic stroke ≤3.6%, surgical site infection ≤2.7%, cerebral vasospasm ≤2.5%, new motor deficit ≤5.9%, aneurysm closure rate ≥97.1%, and at 1-year follow-up: aneurysm closure rate ≥98.0%. At 24 months, benchmark patients had a better score on the modified Rankin scale than nonbenchmark patients. CONCLUSION: This study presents internationally applicable benchmarks for clinically relevant outcomes after microsurgical clipping of UIA.

Dougho Park,1 Byung Hee Kim,1 Sang-Eok Lee,1 Dong Young Kim,2 Yoon Sik Eom,2 Jae Man Cho,3 Joong Won Yang,3 Mansu Kim,3 Heum Dai Kwon3 1Department of Rehabilitation Medicine, Spine and Joint Center, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea; 2Department of Orthopedic Surgery, Spine and Joint Center, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea; 3Department of Neurosurgery, Spine and Joint Center, Pohang Stroke and Spine Hospital, Pohang, Republic of KoreaCorrespondence: Dougho ParkDepartment of Rehabilitation Medicine, Spine and Joint Center, Pohang Stroke and Spine Hospital, 352, Huimang-Daero, Nam-Gu, Pohang, 37659, Republic of KoreaTel +82 54 289 9171Fax +82 54 289 9100Email parkdougho@gmail.comPurpose: A bifid median nerve (BMN) is not a rare variant. This study aimed to investigate the features of carpal tunnel syndrome (CTS) accompanied by BMN.Patients and Methods: In this retrospective study, we defined a BMN group as CTS with BMN and a non-bifid median nerve (NMN) group as CTS without BMN. All hands were assigned to four severity grades according to the findings of electrodiagnosis (EDx): very mild, mild, moderate, and severe. The cross-sectional area (CSA) of the median nerve, palmar bowing of the flexor retinaculum, and persistent median artery (PMA) were assessed by ultrasonography. Numerical pain rating scale (NRS) and symptom duration were assessed as clinical variables.Results: Sixty-four hands (57 patients) and 442 hands (341 patients) were enrolled in the BMN and the NMN groups, respectively. BMN was prevalent in 12.6% of all CTS hands. The distribution of EDx severity grade was milder in the BMN group than in the NMN group (P< 0.001). The CSA of the BMN group was 16.2± 4.1 mm2, slightly larger than 15.1± 4.2 mm2 in the NMN group (P=0.056). The BMN group showed higher NRS than the NMN group (5.5± 1.5 and 4.4± 1.7, respectively; P< 0.001). In the subgroup analys