11-(2,2-Dimethylpropyl)-12-{2-[12-(2,2-dimethylpropyl)- 9,10-dihydro-9,10-ethenoanthracen-11-yl]- ethyl}-9,10-dihydro-9,10-ethenoanthracene

Reaction of tert-butyllithium with 11,12-dimethylene-9,10- dihydro-9,10-ethanoanthracene and 4,5-diiodopentacyclo- [4.3.0.02,4.03,8.05,7]nonane gives three products, one of which crystallizes from petroleum ether as the title compound, C44H46, (I). Molecules of (I) are positioned on inversion centers (Z0 = 0.5) in the space group P21/n and lack any discernible intermolecular interactions

11-(2,2-Dimethylpropyl)-12-{2-[12-(2,2-dimethylpropyl)- 9,10-dihydro-9,10-ethenoanthracen-11-yl]- ethyl}-9,10-dihydro-9,10-ethenoanthracene

Reaction of tert-butyllithium with 11,12-dimethylene-9,10- dihydro-9,10-ethanoanthracene and 4,5-diiodopentacyclo- [4.3.0.02,4.03,8.05,7]nonane gives three products, one of which crystallizes from petroleum ether as the title compound, C44H46, (I). Molecules of (I) are positioned on inversion centers (Z0 = 0.5) in the space group P21/n and lack any discernible intermolecular interactions

Intravenous Cetirizine Versus Intravenous Diphenhydramine for the Treatment of Acute Urticaria: A Phase III Randomized Controlled Noninferiority Trial

STUDY OBJECTIVE: Acute urticaria is a frequent presentation in emergency departments (EDs), urgent care centers, and other clinical arenas. Treatment options are limited if diphenhydramine is the only intravenous antihistamine offered because of its short duration of action and well-known adverse effects. We evaluate cetirizine injection, the first second-generation injectable antihistamine, for acute urticaria in this multicenter, randomized, noninferiority, phase 3 clinical trial. METHODS: Adult patients presenting to EDs and urgent care centers with acute urticaria requiring an intravenous antihistamine were randomized to either intravenous cetirizine 10 mg or intravenous diphenhydramine 50 mg. The primary endpoint was the 2-hour pruritus score change from baseline, with time spent in treatment center and rate of return to treatment centers as key secondary endpoints. Frequency of sedation and anticholinergic adverse effects were also recorded. RESULTS: Among 262 enrolled patients, the 2-hour pruritus score change from baseline for intravenous cetirizine was statistically noninferior to that for intravenous diphenhydramine (-1.6 versus -1.5; 95% confidence interval -0.1 to 0.3), and in favor of cetirizine. Treatment differences also favored cetirizine for mean time spent in treatment center (1.7 versus 2.1 hours; P=.005), return to treatment center (5.5% versus 14.1%; P=.02), lower change from baseline sedation score at 2 hours (0.1 versus 0.5; P=.03), and adverse event rate (3.9% versus 13.3%). CONCLUSION: Intravenous cetirizine is an effective alternative to intravenous diphenhydramine for treating acute urticaria, with benefits of less sedation, fewer adverse events, shorter time spent in treatment center, and lower rates of revisit to treatment center

Delay in Hospital Presentation Is the Main Reason Large Vessel Occlusion Stroke Patients Do Not Receive Intravenous Thrombolysis

OBJECTIVES: Intravenous thrombolysis (IVT) and endovascular therapy (EVT) are the mainstays of treatment for large vessel occlusion stroke (LVOS). Prior studies have examined why patients have not received IVT, the most cited reasons being last-known-well (LKW) to hospital arrival of \u3e4.5 hours and minor/resolving stroke symptoms. Given that LVOS patients typically present moderate-to-severe neurologic deficits, these patients should be easier to identify and treat than patients with minor strokes. This investigation explores why IVT was not administered to a cohort of LVOS patients who underwent EVT. METHODS: This is an analysis of the Optimizing the Use of Prehospital Stroke Systems of Care (OPUS-REACH) registry, which contains patients from 9 endovascular centers who underwent EVT between 2015 and 2020. The exposure of interest was the receipt of intravenous thrombolysis. Descriptive summary statistics are presented as means and SDs for continuous variables and as frequencies with percentages for categorical variables. Two-sample RESULTS: Two thousand forty-three patients were included and 60% did not receive IVT. The most common reason for withholding IVT was LKW to arrival of \u3e4.5 (57.2%). The second most common contraindication was oral anticoagulation (15.5%). On multivariable analysis, 2 factors were associated with not receiving IVT: increasing age (odds ratio [OR] 0.86; 95% confidence interval [CI] 0.78-0.93) and increasing time from LKW-to hospital arrival (OR 0.45 95% CI 0.46-0.49). CONCLUSION: Like prior studies, the most frequent reason for exclusion from IVT was a LKW to hospital presentation of \u3e4.5 hours; the second reason was anticoagulation. Efforts must be made to increase awareness of the time-sensitive nature of IVT and evaluate the safety of IVT in patients on oral anticoagulants

A Shorter Door-In-Door-Out Time Is Associated with Improved Outcome in Large Vessel Occlusion Stroke.

Introduction: Endovascular thrombectomy (EVT) significantly improves outcomes in large vessel occlusion stroke (LVOS). When a patient with a LVOS arrives at a hospital that does not perform EVT, emergent transfer to an endovascular stroke center (ESC) is required. Our objective was to determine the association between door-in-door-out time (DIDO) and 90-day outcomes in patients undergoing EVT. Methods: We conducted an analysis of the Optimizing Prehospital Stroke Systems of Care-Reacting to Changing Paradigms (OPUS-REACH) registry of 2,400 LVOS patients treated at nine ESCs in the United States. We examined the association between DIDO times and 90-day outcomes as measured by the modified Rankin scale. Results: A total of 435 patients were included in the final analysis. The mean DIDO time for patients with good outcomes was 17 minute shorter than patients with poor outcomes (122 minutes [min] vs 139 min, P = 0.04). Absolute DIDO cutoff times of ≤60 min, ≤90 min, or ≤120 min were not associated with improved functional outcomes (46.4 vs 32.3%, P = 0.12; 38.6 vs 30.6%, P = 0.10; and 36.4 vs 28.9%, P = 0.10, respectively). This held true for patients with hyperacute strokes of less than four-hour onset. Lower baseline National Institutes of Health Stroke Scale (NIHSS) score (11.9 vs 18.2, P = \u3c.001) and younger age (62.5 vs 74.9 years (P \u3c .001) were associated with improved outcomes. On multiple regression analysis, age (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.45-2.02) and baseline NIHSS score (OR 1.67, 95% CI 1.42-1.98) were associated with improved outcomes while DIDO time was not associated with better outcome (OR 1.13, 95% CI 0.99-1.30). Conclusion: Although the DIDO time was shorter for patients with a good outcome, this was non-significant in multiple regression analysis. Receipt of intravenous thrombolysis and time to EVT were not associated with better outcomes, while male gender, lower age, arrival by private vehicle, and lower NIHSS score portended better outcomes. No absolute DIDO-time cutoff or modifiable factor was associated with improved outcomes for LVOS. This study underscores the need to streamline DIDO times but not to set an artificial DIDO time benchmark to meet

Delayed Salicylate Toxicity with Undetectable Initial Levels after Large-Dose Aspirin Ingestion

Aspirin (acetylsalicylic acid), the most commonly used medicinal salicylate, is an antiinflammatory, antipyretic, antirheumatic, and analgesic agent. In 2005, according to the Toxic Exposures Survey from the American Association of Poison Control Centers\u27 National Poisoning and Exposure Database, there were more than 20,000 reported aspirin and nonaspirin salicylate exposures, 64% of which required treatment in a health care facility. Of these exposures, 50% were reported as intentional overdoses and 60 patients died

Patrimonialização, Memória Local, Uso e Transformação Social: os casos dos Parques Metropolitanos do Abaeté e de São Bartolomeu (Salvador, Bahia, Brasil)

Tese de doutoramento em Estudos Contemporâneos, apresentada ao Instituto de Investigação Interdisciplinar da Universidade de CoimbraA presente tese tem por objetivo analisar a patrimonialização, como um fenômeno social contemporâneo capaz de contemplar a diversidade cultural. Discute-se a necessidade de inclusão de nossas referências históricas e culturais, principalmente,de grupos historicamente marginalizados na sociedade brasileira. Nesse sentido, a musealização é vista como um processo dinâmico que permite o uso do patrimônio cultural preservado, podendo contribuir para a compreensão das memórias como forma de transformação social. A pesquisa foi desenvolvida a partir de dois estudos de casos, na cidade do Salvador, Bahia, Brasil – os Parques Metropolitanos do Abaeté e de São Bartolomeu-, foram tratados como patrimônio ambiental, urbano e religioso. A metodologia do trabalho contemplou os documentos escritos referentes à patrimonialização, de autoria dos técnicos das instituições responsáveis pelos referidos parques e dos agentes dos movimentos sociais. A coleta de dados obedeceu a um registro de ordem etnográfica, voltado para a observação das atividades e práticas desenvolvidas nesses espaços, como também, a realização de entrevistas. O estudo aponta para o processo incompleto das ações de patrimonialização, a participação ativa dos agentes locais, as tensões e possibilidades de diálogo, demonstrando quea patrimonialização é fundamental, mas que é preciso interpretar e divulgar o patrimônio preservado. Para tanto, é necessário ampliarmos a concepção de museu e de museologia, incorporando os patrimônios advindos de movimentos sociais que estimulam a construção de tipologias e o desenvolvimento de processos museais próprios das realidades socioculturais das coletividades. Esse tipo de patrimonialização permite uma apropriação em torno dos bens culturais e o afloramento de identidades diversas que precisam ser incorporadas às políticas públicas de preservação, sob pena de obtermos uma visão reducionista e parcial das nossas memórias sociais. Além disso, é necessário a construção e o desenvolvimento de políticas educacionais, sociais, culturais e museológicas de forma integrada, com vistas a uma preservação contextualizada e social. É nesse sentido que o turismo pode se constituir como uma ferramenta importante de desenvolvimento social. Patrimonialização, Memória Local, Musealização, Uso e Transformação Social pretende contribuir com os estudos sobre patrimônio cultural e as identidades culturais, nas sociedades contemporâneas e fornecer subsídios para a implantação e implementação de políticas públicas preservacionistas que considerem e invistam na formação de cidadãos participativos, fortalecidos pela compreensão de suas memórias, histórias e lutas.This thesis aims to analyze patrimonialisation as a contemporary social phenomenon able to contemplate cultural diversity. It discusses the need for the inclusion of our historical and cultural references, giving special attention to groups that have been marginalized from the Brazilian society throughout time. In this sense, musealization is seen as a dynamic process that allows the use of preserved cultural heritage and can contribute to the understanding of remembrances as a form of social transformation. The survey was developed from two case studies in the city of Salvador, Bahia, Brazil – the Metropolitan Parks Abaeté and Saint Bartholomew were treated as heritage of an environmental, urban and religious nature. The methodology of the work contemplated written documents concerning patrimony, produced by the technical institutions responsible for these parks and agents of social movements. Data collection followed an ethnographic method of registry aimed at the observation of the activities and practices developed in these spaces, as well as carrying out a series of interviews. The study points to the incomplete nature of the process, the active participation of local actors, the tensions and possibilities of dialogue, demonstrating that patrimonialisation is essential, but the heritage preserved must be interpreted and disseminated. Therefore, it is necessary to broaden our understanding of museums and museology, incorporating the patrimony produced by social movements that stimulate the construction of typologies and the development of museological processes that take into account the sociocultural realities of such communities. This type of patrimonialisation allows an appropriation of cultural items and the emergence of diverse identities that must be incorporated into public preservation policies in order to avoid a reductionist and partial understanding of our social memories. Furthermore, it is necessary to build and develop educational, social, cultural and museological policies in an integrated manner in order to achieve a contextualized and social preservation. It is in this sense that tourism can be seen as an important tool for social development. Patrimonialisation, Local Memory, Musealisation and Social Transformation aims to contribute to the study of cultural heritage and cultural identities in contemporary societies and to aid the establishment and implementation of public preservationist policies which take into account and invest in the training of citizens who, strengthened by an understanding of their memories, stories and struggles may participate fully in their society. Ultimately, patrimonialization does not seem to fulfill the ´preservationist demands of social groups with wide and diversified historical references, rendering musealization and the use of preserved heritage important and necessary as a means of social transformation

Delay in hospital presentation is the main reason large vessel occlusion stroke patients do not receive intravenous thrombolysi.

OBJECTIVES: Intravenous thrombolysis (IVT) and endovascular therapy (EVT) are the mainstays of treatment for large vessel occlusion stroke (LVOS). Prior studies have examined why patients have not received IVT, the most cited reasons being last-known-well (LKW) to hospital arrival of \u3e4.5 hours and minor/resolving stroke symptoms. Given that LVOS patients typically present moderate-to-severe neurologic deficits, these patients should be easier to identify and treat than patients with minor strokes. This investigation explores why IVT was not administered to a cohort of LVOS patients who underwent EVT. METHODS: This is an analysis of the Optimizing the Use of Prehospital Stroke Systems of Care (OPUS-REACH) registry, which contains patients from 9 endovascular centers who underwent EVT between 2015 and 2020. The exposure of interest was the receipt of intravenous thrombolysis. Descriptive summary statistics are presented as means and SDs for continuous variables and as frequencies with percentages for categorical variables. Two-sample RESULTS: Two thousand forty-three patients were included and 60% did not receive IVT. The most common reason for withholding IVT was LKW to arrival of \u3e4.5 (57.2%). The second most common contraindication was oral anticoagulation (15.5%). On multivariable analysis, 2 factors were associated with not receiving IVT: increasing age (odds ratio [OR] 0.86; 95% confidence interval [CI] 0.78-0.93) and increasing time from LKW-to hospital arrival (OR 0.45 95% CI 0.46-0.49). CONCLUSION: Like prior studies, the most frequent reason for exclusion from IVT was a LKW to hospital presentation of \u3e4.5 hours; the second reason was anticoagulation. Efforts must be made to increase awareness of the time-sensitive nature of IVT and evaluate the safety of IVT in patients on oral anticoagulants