Direct mechanical thrombectomy without intravenous thrombolysis versus bridging therapy for acute ischemic stroke:A meta-analysis of randomized controlled trials

Background: Direct mechanical thrombectomy may result in similar outcomes compared to a bridging approach with intravenous thrombolysis (IVT + MT) in acute ischemic stroke. Recent randomized controlled trials have varied in their design and noninferiority margin. Aim: We sought to meta-analyze accumulated trial data to assess the difference and non-inferiority in clinical and procedural outcomes between direct mechanical thrombectomy and bridging therapy. Summary of review: We conducted a systematic review of electronic databases following the preferred reporting items for systematic reviews and meta-analyses guidelines. Random effects meta-analyses were conducted for the pooled data. The primary outcome was good functional outcome at 90 days (modified Rankin scale (mRS) ≤ 2). Secondary outcomes included excellent functional outcome (mRS ≤ 1), mortality, any intracranial hemorrhage, symptomatic intracranial hemorrhage, successful reperfusion (thrombolysis in cerebral infarction ≥ 2 b), and procedure-related complications. Four randomized controlled trials comprising 1633 patients (817 direct mechanical thrombectomy, 816 bridging therapy) were included. There were no statistical differences for the 90-day good functional outcome (OR = 1.02, 95% CI 0.84–1.25, p = 0.54, I2= 0%), and the absolute risk difference was 1% (95% CI: −4% to 5%). The lower 95% CI falls within the strictest noninferiority margin of −10% among included randomized control trials. Direct mechanical thrombectomy reduced the odds of successful reperfusion (OR = 0.76, 95% CI: 0.60–0.97, p = 0.03, I2= 0%) and any intracranial hemorrhage (OR = 0.65, 95% CI: 0.49–0.86, p = 0.003, I2= 38%). There was no difference in the remaining secondary outcomes. The risk of bias for all studies was low. Conclusion: The combined trial data assessing direct mechanical thrombectomy versus bridging therapy showed no difference in improving good functional outcome. The wide noninferiority thresholds set by individual trials are in contrast with the clinical consensus on minimally important differences. However, our pooled analysis indicates noninferiority of direct mechanical thrombectomy with a 4% margin of confidence. The application of these findings is limited to patients presenting directly to mechanical thrombectomy-capable centers and real-world workflow times may differ against those achieved in a trial setting

Skala ASPECTS w udarze niedokrwiennym

Skala ASPECTS (Alberta Stroke Program Early CT Score) powstała na początku XXI wieku jako kwantyfikator wczesnych zmian niedokrwiennych na obrazach tomografii komputerowej u pacjentów podejrzanych o ostry udar niedokrwienny mózgu. Obejmuje zakres od 0 do 10 pkt., gdzie 10 pkt. oznacza stan prawidłowy. Jest ona skorelowana z rokowaniem. Obecnie jest jednym z kryteriów podczas kwalifikacji chorych do trombektomii mechanicznej.  W artykule omówiono historię, rozwój i przyszłość skali ASPECTS oraz opisano praktyczny protokół oceny.

Facile and Robust Solvothermal Synthesis of Nanocrystalline CuInS2 Thin Films

This work demonstrates that the solvothermal synthesis of nanocrystalline CuInS2 thin films using the amino acid l-cysteine as sulfur source is facile and robust against variation of reaction time and temperature. Synthesis was carried out in a reaction time range of 3-48 h (at 150 degrees C) and a reaction temperature range of 100-190 degrees C (for 18 h). It was found that at least a time of 6 h and a temperature of 140 degrees C is needed to produce pure nanocrystalline CuInS2 thin films as proven by X-ray and electron diffraction, high-resolution transmission electron microscopy, and energy-dispersive X-ray spectroscopy. Using UV-vis spectroscopy, a good absorption behavior as well as direct band gaps between 1.46 and 1.55 eV have been determined for all grown films. Only for a reaction time of 3 h and temperatures below 140 degrees C CuInS2 is not formed. This is attributed to the formation of metal ion complexes with l-cysteine and the overall slow assembly of CuInS2. This study reveals that the reaction parameters can be chosen relatively free;the reaction is completely nontoxic and precursors and solvents are rather cheap, which makes this synthesis route interesting for industrial up scaling

Pozytywnie zaczytani – inspiracje, wyzwania, realizacje

Publikacja Pozytywnie zaczytani – inspiracje, wyzwania, realizacje zawiera cztery teksty skierowane do tych wszystkich, którzy biorą czynny udział w kreowaniu kultury czytelniczej w szkole. Cykl otwiera esej prof. Grzegorza Pyszczka, który prezentuje gorąco dyskutowaną kwestię kanonu lektur i ciągłego poszukiwania najlepszych kryteriów służących dokonywaniu właściwych wyborów w procesie jego kreowania. W kolejnym artykule dr Olga Dawidowicz-Chymkowska ukazuje panoramę współczesnej literatury młodzieżowej spod znaku „magii i miecza”, upatrując w tego typu tekstach trafnego narzędzia pedagogicznego i właściwego punktu wyjścia do prowadzenia udanych rozmów z nastoletnimi poszukiwaczami dobrych lektur – rozmów kreujących przyszłego dojrzałego czytelnika. Praktyczne aspekty wdrażania młodzieży do aktywnego czytelnictwa ukazują scenariusze zajęć opracowane przez Małgorzatę Taraszkiewicz, która dostrzega podstawę uniwersalnego wykształcenia przede wszystkim w kulturowej umiejętności odczytania „świata słowami opisanego” we wszelkiego rodzaju literaturze. Zamykający publikację artykuł Anny Grunwald wyraża opinię, że „czytanie jest cool”, i ukazuje, w jaki sposób animacja kulturalna – również w obszarze muzealnictwa – może wspierać praktyki prowadzące do pozytywnego zaczytania młodego pokolenia

Automated quantification of stroke damage on brain computed tomography scans: e-ASPECTS

Emergency radiological diagnosis of acute ischaemic stroke requires the accurate detection and appropriate interpretation of relevant imaging findings. Non-contrast computed tomography (CT) provides fast and low-cost assessment of the early signs of ischaemia and is the most widely used diagnostic modality for acute stroke. The Alberta Stroke Program Early CT Score (ASPECTS) is a quantitative and clinically validated method to measure the extent of ischaemic signs on brain CT scans. The CE-marked electronic-ASPECTS (e-ASPECTS) software automates the ASPECTS score. Anglia Ruskin Clinical Trials Unit (ARCTU) independently carried out a clinical investigation of the e-ASPECTS software, an automated scoring system which can be integrated into the diagnostic pathway of an acute ischaemic stroke patient, thereby assisting the physician with expert interpretation of the brain CT scan. Here we describe a literature review of the clinical importance of reliable assessment of early ischaemic signs on plain CT scans, and of technologies automating these processed scoring systems in ischaemic stroke on CT scans focusing on the e-ASPECTS software. To be suitable for critical appraisal in this evaluation, the published studies needed a sample size of a minimum of 10 cases. All randomised studies were screened and data deemed relevant to demonstration of performance of ASPECTS were appraised. The literature review focused on three domains: i) interpretation of brain CT scans of stroke patients, ii) the application of the ASPECTS score in ischaemic stroke, and iii) automation of brain CT analysis. Finally, the appraised references are discussed in the context of the clinical impact of e-ASPECTS and the expected performance, which will be independently evaluated by a non-inferiority study conducted by the ARCTU