Understanding the neuroprotective effect of tranexamic acid: an exploratory analysis of the CRASH-3 randomised trial.

BACKGROUND: The CRASH-3 trial hypothesised that timely tranexamic acid (TXA) treatment might reduce deaths from intracranial bleeding after traumatic brain injury (TBI). To explore the mechanism of action of TXA in TBI, we examined the timing of its effect on death. METHODS: The CRASH-3 trial randomised 9202 patients within 3 h of injury with a GCS score ≤ 12 or intracranial bleeding on CT scan and no significant extracranial bleeding to receive TXA or placebo. We conducted an exploratory analysis of the effects of TXA on all-cause mortality within 24 h of injury and within 28 days, excluding patients with a GCS score of 3 or bilateral unreactive pupils, stratified by severity and country income. We pool data from the CRASH-2 and CRASH-3 trials in a one-step fixed effects individual patient data meta-analysis. RESULTS: There were 7637 patients for analysis after excluding patients with a GCS score of 3 or bilateral unreactive pupils. Of 1112 deaths, 23.3% were within 24 h of injury (early deaths). The risk of early death was reduced with TXA (112 (2.9%) TXA group vs 147 (3.9%) placebo group; risk ratio [RR] RR 0.74, 95% CI 0.58-0.94). There was no evidence of heterogeneity by severity (p = 0.64) or country income (p = 0.68). The risk of death beyond 24 h of injury was similar in the TXA and placebo groups (432 (11.5%) TXA group vs 421 (11.7%) placebo group; RR 0.98, 95% CI 0.69-1.12). The risk of death at 28 days was 14.0% in the TXA group versus 15.1% in the placebo group (544 vs 568 events; RR 0.93, 95% CI 0.83-1.03). When the CRASH-2 and CRASH-3 trial data were pooled, TXA reduced early death (RR 0.78, 95% CI 0.70-0.87) and death within 28 days (RR 0.88, 95% CI 0.82-0.94). CONCLUSIONS: Tranexamic acid reduces early deaths in non-moribund TBI patients regardless of TBI severity or country income. The effect of tranexamic acid in patients with isolated TBI is similar to that in polytrauma. Treatment is safe and even severely injured patients appear to benefit when treated soon after injury. TRIAL REGISTRATION: ISRCTN15088122 , registered on 19 July 2011; NCT01402882 , registered on 26 July 2011

An MIMO rectangular dielectric resonator antenna for 4G applications

A multiple-input-multiple-output (MIMO) rectangular dielectric resonator antenna (RDRA) for 2.6-GHz Long Term Evolution (LTE) applications is investigated and presented. Two orthogonal modes of the RDRA are excited by using two different feed mechanisms: coplanar waveguide (CPW) and coaxial probe. The measured impedance bandwidth for port 1 and port 2 is 47% (2.09-3.38 GHz) and 25% (2.40-3.09 GHz), respectively. The measured correlation coefficient is 0.03 with nearly 10 dB diversity gain at frequency 2.6 GHz. The MIMO RDRA gives isoltion of above 20 dB over the operating frequency. The gain of 4.97 dBi is obtained for port 1 and 4.51 dBi for port 2 at 2.6 GHz. The S-parameters, isolation, gain, correlation coefficient, and diversity gain of the MIMO RDRA are studied, and reasonable agreement between the measured and simulated results is observed. © 2002-2011 IEEE

An MIMO F-shaped dielectric resonator antenna for 4G applications

© 2015 Wiley Periodicals, Inc.A multiple input multiple output (MIMO) F-shaped dielectric resonator antenna (DRA) for mobile device is presented in this article. The F-shaped DRA is mounted on FR4 as a substrate. The measured impedance bandwidth for Port 1 is 36% (2.30-3.31 GHz) while Port 2 is 31% (2.30-3.14 GHz), respectively with isolation of -33 dB. Two orthognal modes are excited in this design which are TE1δ1y mode at Port1 and TEδ11x at Port 2. Correlation coefficient of a MIMO F-shaped DRA is 0.04 with diversity gain nearly 10 dB over operating frequency. The antenna provides gain 1.99 dBi for Port 1 and 1.85 dBi for Port 2 at frequency 2.6 GHz. The parameters, isolation, gain, correlation coefficient, and diversity gain of the MIMO rectangular dielectric resonator antenna are studied, and reasonable agreement between the measured and simulated results is observed

A coplanar waveguide rectangular dielectric resonator antenna (RDRA) for 4G applications

© 2015 Penerbit UTM Press. All rights reserved.This paper presents the design of coplanar waveguide (CPW) rectangular dielectric resonator antenna (RDRA) with and without metallic strip, operating at 2.6 GHz for long term evolution (LTE) applications. The CPW RDRA without metallic strip produces impedance bandwidth of 51 %. Then, a metallic strip was added on top of the dielectric resonator (DR) in order to enhance the impedance bandwidth; thus give more flexibility for the system to cover more applications. A good agreement between simulation and measurement results, in terms of reflection coefficient magnitude and radiation pattern is presented. The simulated and measured impedance BWs for S11 <-6dB are 67 % (1.74-3.47 GHz) and 66 % (1.83-3.54 GHZ) respectively, with the gain of 3.12 dBi is obtained at 2.6 GHz. The mode excited for this antenna is TEy1δ1 mode

Resistin and NGAL are associated with inflammatory response, endothelial activation and clinical outcomes in sepsis

© 2017, Springer International Publishing. Objective and design: Resistin and neutrophil gelatinase-associated lipocalin (NGAL) are upregulated in circulating leucocytes in sepsis, but the significance of this is uncertain. We evaluated associations between Resistin and NGAL with endothelial cell activation and clinical outcomes in a prospective observational study in the Emergency Department (ED). Methods: Serum levels of Resistin, NGAL, inflammatory cytokines (IL-6, IL-10) and soluble endothelial adhesion molecules (VCAM-1, ICAM-1) were measured at defined time points up to 24 h. Patterns and relationships between markers were investigated using linear mixed regression models. Predictive values for clinical outcomes for markers at enrollment were assessed by logistic regression and receiver operator characteristic (ROC) curves. Results: 186 participants (89 septic-shock, 69 sepsis, 28 uncomplicated infection) were compared with 29 healthy controls. Median Resistin and NGAL were higher in uncomplicated infection compared to controls, and in septic shock compared to non-shock sepsis. Resistin and NGAL correlated with IL-6 and IL-10, with VCAM-1 and ICAM-1, and with organ failure. Resistin and NGAL were associated with septic shock but had limited predictive utility for mortality. Conclusion: Resistin and NGAL correlate with expression of endothelial cell adhesion molecules in sepsis. Further evaluation of the role of Resistin and NGAL in sepsis pathogenesis is warranted