21 research outputs found

    Safety and efficacy of tenecteplase in patients with wake-up stroke assessed by non-contrast CT (TWIST): a multicentre, open-label, randomised controlled trial

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    Background: Current evidence supports the use of intravenous thrombolysis with alteplase in patients with wake-up stroke selected with MRI or perfusion imaging and is recommended in clinical guidelines. However, access to advanced imaging techniques is often scarce. We aimed to determine whether thrombolytic treatment with intravenous tenecteplase given within 4·5 h of awakening improves functional outcome in patients with ischaemic wake-up stroke selected using non-contrast CT. Methods: TWIST was an investigator-initiated, multicentre, open-label, randomised controlled trial with blinded endpoint assessment, conducted at 77 hospitals in ten countries. We included patients aged 18 years or older with acute ischaemic stroke symptoms upon awakening, limb weakness, a National Institutes of Health Stroke Scale (NIHSS) score of 3 or higher or aphasia, a non-contrast CT examination of the head, and the ability to receive tenecteplase within 4·5 h of awakening. Patients were randomly assigned (1:1) to either a single intravenous bolus of tenecteplase 0·25 mg per kg of bodyweight (maximum 25 mg) or control (no thrombolysis) using a central, web-based, computer-generated randomisation schedule. Trained research personnel, who conducted telephone interviews at 90 days (follow-up), were masked to treatment allocation. Clinical assessments were performed on day 1 (at baseline) and day 7 of hospital admission (or at discharge, whichever occurred first). The primary outcome was functional outcome assessed by the modified Rankin Scale (mRS) at 90 days and analysed using ordinal logistic regression in the intention-to-treat population. This trial is registered with EudraCT (2014–000096–80), ClinicalTrials.gov (NCT03181360), and ISRCTN (10601890). Findings: From June 12, 2017, to Sept 30, 2021, 578 of the required 600 patients were enrolled (288 randomly assigned to the tenecteplase group and 290 to the control group [intention-to-treat population]). The median age of participants was 73·7 years (IQR 65·9–81·1). 332 (57%) of 578 participants were male and 246 (43%) were female. Treatment with tenecteplase was not associated with better functional outcome, according to mRS score at 90 days (adjusted OR 1·18, 95% CI 0·88–1·58; p=0·27). Mortality at 90 days did not significantly differ between treatment groups (28 [10%] patients in the tenecteplase group and 23 [8%] in the control group; adjusted HR 1·29, 95% CI 0·74–2·26; p=0·37). Symptomatic intracranial haemorrhage occurred in six (2%) patients in the tenecteplase group versus three (1%) in the control group (adjusted OR 2·17, 95% CI 0·53–8·87; p=0·28), whereas any intracranial haemorrhage occurred in 33 (11%) versus 30 (10%) patients (adjusted OR 1·14, 0·67–1·94; p=0·64). Interpretation: In patients with wake-up stroke selected with non-contrast CT, treatment with tenecteplase was not associated with better functional outcome at 90 days. The number of symptomatic haemorrhages and any intracranial haemorrhages in both treatment groups was similar to findings from previous trials of wake-up stroke patients selected using advanced imaging. Current evidence does not support treatment with tenecteplase in patients selected with non-contrast CT. Funding: Norwegian Clinical Research Therapy in the Specialist Health Services Programme, the Swiss Heart Foundation, the British Heart Foundation, and the Norwegian National Association for Public Health

    Joint Impact of CSR Policy and Market Structure on Environmental Sustainability in Supply Chains

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    International audienceThe integration of Corporate Social Responsibility (CSR) and Smart Manufacturing (SM) has emerged as a promising strategy for addressing carbon emissions. Governments can play a crucial role in promoting sustainable practices and environmental sustainability by implementing targeted policies and regulations. In this study, we examine the sustainability performance of competing smart supply chains that offer substitutable products under different CSR regulatory policies. Specifically, we investigate five CSR policies: Deregulation, Direct Tariff on Market, Sustainability Penalty and Credits, Direct Limitation on Sustainability, and Government Cooperative Sustainability Efforts. Using a game theoretical framework, we model and analyze the effectiveness of each CSR policy within monopoly and oligopoly market structures. Our results uncover the importance of considering the synergistic effects of market structure and CSR when designing sustainability strategies for policymakers and supply chain managers. For instance, the Direct Tariff on Market policy in the monopoly market is shown to be the preferred regulatory approach as it effectively enhances both supply chain profitability and environmental sustainability. Furthermore, the Direct Tariff on Market policy in the oligopoly market, along with the Direct Limitation on Sustainability policy in the monopoly market, results in a greater market share of sustainable products. Understanding these dynamics enables policymakers to make informed decisions that maximize the environmental benefits of CSR practices, considering varying market structures. \textcopyright 2023 The Author(s

    Electrophoretic deposition of graphene oxide on magnetic ribbon: Toward high sensitive and selectable magnetoimpedance response

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    Graphene oxide (GO) layers have shown to be fascinating elements for application in high performance sensors. They can be applied in multi-disciplinary designs based on surface selective sensing mechanisms. One immediate application of such surface sensitive elements is implementing of GO layer in magnetoimpedance (MI) sensors to improve their multi-functionality. In this paper, deposition of GO on the surface of Co-based amorphous ribbons (Co 68.15 Fe 4.35 Si 12.5 B 15 ) is performed using electrophoretic deposition (EPD) method to evaluate the MI response. MI ratio increased from 271% (bare ribbon) up to 281% and 301% EPD GO deposited within 4 and 8 min, respectively. Similar experiment for the ribbon drop coated with GO was carried out while no enhancement in MI response was seen. Vertical growth of GO on the surface of the ribbon in EPD and drop coated layers observed by topographical measurements. We explained the difference between the MI responses based on layers verticality and surface coverage. UV–Visible absorption and Raman spectroscopy were used to study the nature of GO. Gaining a high surface area of GO along with their biocompatible and anticorrosive properties atop the MI sensors can open pathways towards increasing applications of surface selective and high sensitive MI sensors

    The Drosha rs10719 T>C polymorphism is associated with preeclampsia susceptibility

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    Purpose: Drosha is a member of the micro RNA (miRNA) processing machinery that affects miRNA processing. Single-nucleotide polymorphisms (SNPs) in the Drosha gene might affect microRNA processing and the expression of various genes. The aim of this study is to investigate the association between SNPs in the Drosha gene and preeclampsia (PE) in the southeast of Iran. Methods: Genotyping of Drosha rs10719 and rs6877842 was performed using blood samples from 219 PE women and 205 healthy control subjects by a polymerase chain reaction-restriction fragment length polymorphism method. Results: The Drosha rs10719TC genotype was significantly associated with 1.6-fold higher risk of PE (odds ratio (OR, 1.6 95% CI, 1.1�2.4, P = 0.026). In addition, the frequency of the Drosha rs10719CC genotype was significantly higher in PE women and was associated with threefold higher risk of PE (OR 3 95% CI 1.4�6.3, P = 0.004). There was no association between the Drosha rs6877842 polymorphism and PE susceptibility. The CC�GG combined genotype was associated with 3.4-fold higher risk of PE (OR 3.4 95% CI 1.4�8.1, P = 0.007). The haplotype-based association analysis showed higher frequency of C�G haplotype of Drosha rs10719 and rs6877842 polymorphisms with the increased risk of PE 1.5-fold (OR 1.5 95% CI 1.1�2, P = 0.01). Conclusions: The Drosha rs10719TC and CC genotypes were associated with PE risk. The CC�GG combined genotype and C�G haplotype of Drosha rs10719 and rs6877842 polymorphisms may increase PE susceptibility. © 2018 Taylor & Francis
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