Safety and efficacy of intra-arterial fibrinolytics as adjunct to mechanical thrombectomy : a systematic review and meta-analysis of observational data

Background Achieving the best possible reperfusion is a key determinant of clinical outcome after mechanical thrombectomy (MT). However, data on the safety and efficacy of intra-arterial (IA) fibrinolytics as an adjunct to MT with the intention to improve reperfusion are sparse. Methods We performed a PROSPERO-registered (CRD42020149124) systematic review and meta-analysis accessing MEDLINE, PubMed, and Embase from January 1, 2000 to January 1, 2020. A random-effect estimate (Mantel-Haenszel) was computed and summary OR with 95% CI were used as a measure of added IA fibrinolytics versus control on the risk of symptomatic intracranial hemorrhage (sICH) and secondary endpoints (modified Rankin ScalePeer reviewe

Safety and efficacy of intra-arterial fibrinolytics as adjunct to mechanical thrombectomy: A systematic review and meta-analysis of observational data

Background: Achieving the best possible reperfusion is a key determinant of clinical outcome after mechanical thrombectomy (MT). However, data on the safety and efficacy of intra-arterial (IA) fibrinolytics as an adjunct to MT with the intention to improve reperfusion are sparse. Methods: We performed a PROSPERO-registered (CRD42020149124) systematic review and meta-analysis accessing MEDLINE, PubMed, and Embase from January 1, 2000 to January 1, 2020. A random-effect estimate (Mantel-Haenszel) was computed and summary OR with 95% CI were used as a measure of added IA fibrinolytics versus control on the risk of symptomatic intracranial hemorrhage (sICH) and secondary endpoints (modified Rankin Scale ≤2, mortality at 90 days). Results: The search identified six observational cohort studies and three observational datasets of MT randomized-controlled trial data reporting on IA fibrinolytics with MT as compared with MT alone, including 2797 patients (405 with additional IA fibrinolytics (100 urokinase (uPA), 305 tissue plasminogen activator (tPA)) and 2392 patients without IA fibrinolytics). Of 405 MT patients treated with additional IA fibrinolytics, 209 (51.6%) received prior intravenous tPA. We did not observe an increased risk of sICH after administration of IA fibrinolytics as adjunct to MT (OR 1.06, 95% CI 0.64 to 1.76), nor excess mortality (0.81, 95% CI 0.60 to 1.08). Although the mode of reporting was heterogeneous, some studies observed improved reperfusion after IA fibrinolytics. Conclusion: The quality of evidence regarding peri-interventional administration of IA fibrinolytics in MT is low and limited to observational data. In highly selected patients, no increase in sICH was observed, but there is large uncertainty

Decision support systems for nuclear reactor control

The main objective of this work is to investigate the use of Fuzzy Logic (FL) techniques to assist nuclear reactor operators to identify the causes of faults or accidents and to cope more efficiently with any abnormal situation that might occur in the nuclear power plant. This study is based on the reduced order model of the Loss of Fluid Test (LOFT) reactor a small scale pressurised water reactor, based at the Idaho test facility. The work described in this thesis addresses three important issues related to the improvement in fault diagnosis for nuclear reactors used fuzzy logic techniques, which are the development of a validated simulation in SIMULINK of the reduced order model of the LOFT reactor and the development of methods for fault injection for the simulation. A detailed analysis of the symptoms of faults has been carried out. Using the simulation and fuzzy logic approaches for identifying the faults from the symptoms have been evaluated. (author)Available from British Library Document Supply Centre-DSC:DXN041927 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Management of Black Mold of Onion [Aspergillus niger (Van Teigh)] by using Various Fungicides

Not AvailableIn onion, among the postharvest diseases, black mold rot caused by Aspergillus niger is the predominant one. The pathogen is transmitted by contaminated seed or soil. The infection usually begins at germination of onion seeds and may continue throughout storage. The purpose of the study was to explore the control of black mold of onion with various systemic, non systemic and combination of fungicides by treating the seeds. Considering per cent reduction of radial growth of Aspergillus niger, non systemic fungicide dinocap (90.28) and thiram (80.28), systemic fungicide carbendazim (100) and tebuconazole (100), and combination of fungicides tebuconazole + trifioxystrobin (100) and pyraclostrobin + epoxyconazole (100) were recommended to use in pot trail. Out of these six different fungicides tebuconazole + trifioxystrobin treated seeds gave minimum per cent mortality 23.33 and maximum per cent germination 83.33 and vigour index 1091.62, respectively under pot trail

Effect of Botanicals and Bioagents on Growth of Aspergillus niger (Van Tiegh) Causing Black Mold in Onion

Not AvailableFor eco friendly, cost effective and non phytotoxic management eight phytoextracts were tested against black mold (Aspergillus niger) of onion under in vitro condition. Out of eight phytoextracts, maximum inhibition 71.19 per cent was found in Lawsonia inermis which followed by Ocimum sanctum leaf extract (62.97%), Zingiber officinale rhizome extract (62.26%) and Lantana camera leaf extract (61.59%). Minimum inhibition of test fungus was recorded in Jetropha curcas leaf extract (53.20%). Among the six biocontrol agents, Tricoderma viride isolate 6 significantly reduced the growth (78.63%) of test fungus followed by the isolate T. viride isolate-9 with (75.51%) growth inhibition, while least antagonism (61.27%) was obtained with biocontrol agent Basillus subtilis.Not Availabl

Magnitude of blood pressure change and clinical outcomes after thrombectomy in stroke caused by large artery occlusion

Background: Extremes of both high and low systolic blood pressure (SBP) after mechanical thrombectomy (MT) in large artery occlusion stroke are known predictors of unfavorable outcome. However, the effect of SBP change (∆SBP) during the first 24 h on thrombectomy outcomes remains unclear. We aimed to investigate the association between ∆SBP at different time intervals and thrombectomy outcomes. Methods: We analyzed MT-treated patients registered in the SITS International Stroke Thrombectomy Registry from January 1, 2014 to September 3, 2019. Primary outcome was 3-month unfavorable outcome (modified Rankin scale scores 3–6). We defined ∆SBP as the mean SBP of a given time interval after MT (0–2, 2–4, 4–12, 12–24 h) minus admission SBP. Multivariable mixed logistic regression models were used to adjust for known confounders and center as random effect. Subgroup analyses were included to contrast specific subpopulations. Restricted cubic splines were used to model the associations. Results: The study population consisted of 5835 patients (mean age 70 years, 51% male, median NIHSS 16). Mean ∆SBP was −12.3, −15.7, −17.2, and −16.9 mmHg for the time intervals 0–2, 2–4, 4–12 h, and 12–24 h, respectively. Higher ∆SBP was associated with unfavorable outcome at 0–2 h (odds ratio 1.065, 95% confidence interval 1.014–1.118), 2–4 h (1.140, 1.081–1.203), 4–12 h (1.145, 1.087–1.203), and 12–24 h (1.145, 1.089–1.203), for every increase of 10 mmHg. Restricted cubic spline models suggested that increasing ∆SBP was associated with unfavorable outcome, with higher values showing increased risk of unfavorable outcome. Conclusion: SBP increase after thrombectomy in large artery occlusion stroke is associated with poor functional outcome. © 2021 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurolog

Endovascular management of acute postprocedural flow diverting stent thrombosis.

INTRODUCTION: Postprocedural thrombosis is a rare complication after flow diverting stent (FD) implantation for aneurysm treatment with few reported cases in the literature. Management strategies and outcomes associated with this complication have not been reported. METHODS: A multicenter retrospective series of cases of acute postprocedural FD thrombosis were compiled and prevalence was calculated based on procedural volumes over a 7 year period. Acute postprocedural FD thrombosis was defined as the development of neurologic deficit with angiographic imaging demonstrating acute thrombus within the index FD stent at least 2 hours following completion of the implantation procedure. RESULTS: A total of 10 cases of postprocedural thrombosis were identified at five participating centers among a total of 768 patients treated (prevalence 1.3%). Thrombosis occurred a median of 5.5 days after implantation (range 0-83 days). 9/10 patients underwent emergent angiography with intent to perform endovascular reperfusion. A variety of different endovascular treatments were used, including aspiration thrombectomy, retrievable stent thrombectomy, balloon angioplasty, and intra-arterial thrombolytic infusion, without any procedural complications. There were no instances of FD migration, stent kinking, or aneurysm rupture. 90% of patients achieved Thrombolysis in Cerebral Infarction 2B or greater revascularization. Favorable clinical outcomes (modified Rankin Scale score of 0-2) at 3 months were achieved in 88% of patients. CONCLUSION: Acute postprocedural thrombosis of an FD is a rare complication that occurs in approximately 1-2% of patients after aneurysm treatment. Patients presenting with acute postprocedural FD thrombosis should be aggressively managed using large vessel occlusion thrombectomy techniques, as good angiographic and clinical outcomes are possible