Tirofiban for Stroke without Large or Medium-Sized Vessel Occlusion

The effects of the glycoprotein IIb/IIIa receptor inhibitor tirofiban in patients with acute ischemic stroke but who have no evidence of complete occlusion of large or medium-sized vessels have not been extensively studied. In a multicenter trial in China, we enrolled patients with ischemic stroke without occlusion of large or medium-sized vessels and with a National Institutes of Health Stroke Scale score of 5 or more and at least one moderately to severely weak limb. Eligible patients had any of four clinical presentations: ineligible for thrombolysis or thrombectomy and within 24 hours after the patient was last known to be well; progression of stroke symptoms 24 to 96 hours after onset; early neurologic deterioration after thrombolysis; or thrombolysis with no improvement at 4 to 24 hours. Patients were assigned to receive intravenous tirofiban (plus oral placebo) or oral aspirin (100 mg per day, plus intravenous placebo) for 2 days; all patients then received oral aspirin until day 90. The primary efficacy end point was an excellent outcome, defined as a score of 0 or 1 on the modified Rankin scale (range, 0 [no symptoms] to 6 [death]) at 90 days. Secondary end points included functional independence at 90 days and a quality-of-life score. The primary safety end points were death and symptomatic intracranial hemorrhage. A total of 606 patients were assigned to the tirofiban group and 571 to the aspirin group. Most patients had small infarctions that were presumed to be atherosclerotic. The percentage of patients with a score of 0 or 1 on the modified Rankin scale at 90 days was 29.1% with tirofiban and 22.2% with aspirin (adjusted risk ratio, 1.26; 95% confidence interval, 1.04 to 1.53, P = 0.02). Results for secondary end points were generally not consistent with the results of the primary analysis. Mortality was similar in the two groups. The incidence of symptomatic intracranial hemorrhage was 1.0% in the tirofiban group and 0% in the aspirin group. In this trial involving heterogeneous groups of patients with stroke of recent onset or progression of stroke symptoms and nonoccluded large and medium-sized cerebral vessels, intravenous tirofiban was associated with a greater likelihood of an excellent outcome than low-dose aspirin. Incidences of intracranial hemorrhages were low but slightly higher with tirofiban

Methylprednisolone as Adjunct to Endovascular Thrombectomy for Large-Vessel Occlusion Stroke

Importance It is uncertain whether intravenous methylprednisolone improves outcomes for patients with acute ischemic stroke due to large-vessel occlusion (LVO) undergoing endovascular thrombectomy. Objective To assess the efficacy and adverse events of adjunctive intravenous low-dose methylprednisolone to endovascular thrombectomy for acute ischemic stroke secondary to LVO. Design, Setting, and Participants This investigator-initiated, randomized, double-blind, placebo-controlled trial was implemented at 82 hospitals in China, enrolling 1680 patients with stroke and proximal intracranial LVO presenting within 24 hours of time last known to be well. Recruitment took place between February 9, 2022, and June 30, 2023, with a final follow-up on September 30, 2023.InterventionsEligible patients were randomly assigned to intravenous methylprednisolone (n = 839) at 2 mg/kg/d or placebo (n = 841) for 3 days adjunctive to endovascular thrombectomy. Main Outcomes and Measures The primary efficacy outcome was disability level at 90 days as measured by the overall distribution of the modified Rankin Scale scores (range, 0 [no symptoms] to 6 [death]). The primary safety outcomes included mortality at 90 days and the incidence of symptomatic intracranial hemorrhage within 48 hours. Results Among 1680 patients randomized (median age, 69 years; 727 female [43.3%]), 1673 (99.6%) completed the trial. The median 90-day modified Rankin Scale score was 3 (IQR, 1-5) in the methylprednisolone group vs 3 (IQR, 1-6) in the placebo group (adjusted generalized odds ratio for a lower level of disability, 1.10 [95% CI, 0.96-1.25]; P = .17). In the methylprednisolone group, there was a lower mortality rate (23.2% vs 28.5%; adjusted risk ratio, 0.84 [95% CI, 0.71-0.98]; P = .03) and a lower rate of symptomatic intracranial hemorrhage (8.6% vs 11.7%; adjusted risk ratio, 0.74 [95% CI, 0.55-0.99]; P = .04) compared with placebo. Conclusions and Relevance Among patients with acute ischemic stroke due to LVO undergoing endovascular thrombectomy, adjunctive methylprednisolone added to endovascular thrombectomy did not significantly improve the degree of overall disability.Trial RegistrationChiCTR.org.cn Identifier: ChiCTR210005172

Hybrid traffic scheduling in time‐sensitive networking for the support of automotive applications

Abstract Time‐sensitive networking (TSN) is considered one of the most promising solutions to address real‐time scheduling in in‐vehicle network due to its capabilities for providing deterministic service. The TSN working group proposed various traffic shaping mechanisms, while deterministic scheduling of hybrid traffic is still not effectively solved since the traffic requirements are difficult to satisfy by standalone or combined mechanisms with fixed time slot divisions. This article presents a time‐aware multi‐cyclicqueuing and forwarding scheduling model, that integrates the no‐wait enabled time‐aware shaper and multi‐cyclic queuing and forwarding shaping models. Then, a scheduling solution, dubbed “TSN scheduling optimizer” (TSO) is proposed that combines optimization methods and incremental techniques. TSO aims to balance the load to maximize flow schedulability while guaranteeing the service requirements of hybrid traffic. Simulation evaluations through OMNeT++ provide a performance assessment of this proposed scheduling model, which can satisfy multiple types of traffic transmission requirements. Furthermore, TSO is compared with other baseline scheduling solutions, and TSO shows efficacy regarding execution time and schedulability

The mechanism of directional fracture controlled blasting and its application

Synthetically using methods including high speed laser tattoo shadow, super dynamic strain testing technology, digital laser dynamic caustics experimental system, this paper studies the cutting seam cartridge explosion wave propagation mechanism, multi-angle observation of the detonation wave propagation process, clearly observed explosion stress wave and explosive gas separating phenomenon.Air interval cutting seam cartridge blasting cement mortar model testing was carried out.The spatial distribution law of stress was summarized.The cutting seam cartridge decoupling blasting explosive raw crack dynamic fracture effect was analyzed.The different charge structures influence on critical raw crack extension was compared.The best decoupling coefficient is 1.67 with directional fracture controlled blasting effect was determined.It studied double hole grooving method, initiation at the same time, through the crack between the two hole and the hole of the lateral dynamic behavior of crack propagation.Finally the cutting seam cartridge directional fracture controlled blasting technology was applied in shaft and tunnel blasting construction.The directional fracture of cutting seam cartridge blasting effect was verified.This research will provide experimental basis and theoretical guidance for engineering practice

Prediction and Selection of Appropriate Landscape Metrics and Optimal Scale Ranges Based on Multi-Scale Interaction Analysis

Landscape metrics are widely used in landscape planning and land use management. Understanding how landscape metrics respond with scales can provide more accurate prediction information; however, ignoring the interference of multi-scale interaction may lead to a severe systemic bias. In this study, we quantitatively analyzed the scaling sensitivity of metrics based on multi-scale interaction and predict their optimal scale ranges. Using a big data method, the multivariate adaptive regression splines model (MARS), and the partial dependence model (PHP), we studied the scaling relationships of metrics to changing scales. The results show that multi-scale interaction commonly exists in most landscape metric scaling responses, making a significant contribution. In general, the scaling effects of the three scales (i.e., spatial extent, spatial resolution, and classification of land use) are often in a different direction, and spatial resolution is the primary driving scale in isolation. The findings show that only a few metrics are highly sensitive to the three scales throughout the whole scale spectrum, while the other metrics are limited within a certain threshold range. This study confirms that the scaling-sensitive scalograms can be used as an application guideline for selecting appropriate landscape metrics and optimal scale ranges

Prediction and Selection of Appropriate Landscape Metrics and Optimal Scale Ranges Based on Multi-Scale Interaction Analysis

Landscape metrics are widely used in landscape planning and land use management. Understanding how landscape metrics respond with scales can provide more accurate prediction information; however, ignoring the interference of multi-scale interaction may lead to a severe systemic bias. In this study, we quantitatively analyzed the scaling sensitivity of metrics based on multi-scale interaction and predict their optimal scale ranges. Using a big data method, the multivariate adaptive regression splines model (MARS), and the partial dependence model (PHP), we studied the scaling relationships of metrics to changing scales. The results show that multi-scale interaction commonly exists in most landscape metric scaling responses, making a significant contribution. In general, the scaling effects of the three scales (i.e., spatial extent, spatial resolution, and classification of land use) are often in a different direction, and spatial resolution is the primary driving scale in isolation. The findings show that only a few metrics are highly sensitive to the three scales throughout the whole scale spectrum, while the other metrics are limited within a certain threshold range. This study confirms that the scaling-sensitive scalograms can be used as an application guideline for selecting appropriate landscape metrics and optimal scale ranges

Field Radiometric Calibration of a Micro-Spectrometer Based on Remote Sensing of Plateau Inland Water Colors

Remote sensing reflectance (Rrs), which is currently measured mainly using the above-water approach, is the most crucial parameter in the remote sensing inversion of plateau inland water colors. It is very difficult to measure the Rrs of plateau inland unmanned areas; thus, we provide a measurement solution using a micro-spectrometer. Currently, commercial micro-spectrometers are not factory calibrated for radiation, and thus, a radiometric calibration of the micro-spectrometer is an essential step. This article uses an Ocean Optics micro-spectrometer (STS-VIS) and a traditional water spectrometer (Trios) to simultaneously measure the irradiance and radiance of diffuse reflectance plates with different reflectance values for field calibration. The results show the following: (1) different fiber types have different calibration coefficients, and the integration time is determined according to the diameter of the fiber and the type of fiber, and (2) by comparing the simultaneous measurement results of STS-VIS with Trios, the mean absolute percentage difference (MAPD) of both reached 18.64% and 5.11% for Qinghai Lake and Golmud River, respectively, which are accurate Rrs measurements of water bodies. The Rrs of the Hoh Xil and Qarhan Salt Lake water bodies in unmanned areas of China was measured, and this was the first collection of in situ spectral information with a micro-spectrometer. This article shows that the micro-spectrometer can perform the in situ measurement of water Rrs in unmanned inland areas. With this breakthrough in the radiometric performance of the micro-spectrometer, we are able to obtain more accurate remote sensing reflectance results of unmanned water bodies

Field Radiometric Calibration of a Micro-Spectrometer Based on Remote Sensing of Plateau Inland Water Colors

Remote sensing reflectance (Rrs), which is currently measured mainly using the above-water approach, is the most crucial parameter in the remote sensing inversion of plateau inland water colors. It is very difficult to measure the Rrs of plateau inland unmanned areas; thus, we provide a measurement solution using a micro-spectrometer. Currently, commercial micro-spectrometers are not factory calibrated for radiation, and thus, a radiometric calibration of the micro-spectrometer is an essential step. This article uses an Ocean Optics micro-spectrometer (STS-VIS) and a traditional water spectrometer (Trios) to simultaneously measure the irradiance and radiance of diffuse reflectance plates with different reflectance values for field calibration. The results show the following: (1) different fiber types have different calibration coefficients, and the integration time is determined according to the diameter of the fiber and the type of fiber, and (2) by comparing the simultaneous measurement results of STS-VIS with Trios, the mean absolute percentage difference (MAPD) of both reached 18.64% and 5.11% for Qinghai Lake and Golmud River, respectively, which are accurate Rrs measurements of water bodies. The Rrs of the Hoh Xil and Qarhan Salt Lake water bodies in unmanned areas of China was measured, and this was the first collection of in situ spectral information with a micro-spectrometer. This article shows that the micro-spectrometer can perform the in situ measurement of water Rrs in unmanned inland areas. With this breakthrough in the radiometric performance of the micro-spectrometer, we are able to obtain more accurate remote sensing reflectance results of unmanned water bodies

The Nutrient and Heavy Metal Contents in Water of Tidal Creek of the Yellow River Delta, China: Spatial Variations, Pollution Statuses, and Ecological Risks

In order to understand the spatial distribution, ecological risks, and pollution status of nutrients and heavy metals in the coastal tidal creek water of the Yellow River Delta (YRD), a total of 21 water samples were collected from 7 sample sites. The results indicated that along the coastline from northwest to southeast in the YRD, the concentrations of TN, TP, and NH4+-N in the water decreased and then increased; the Cu concentration increased, decreased, and then increased; and the Pb concentration decreased. The average TN/TP mass ratio indicated that the tidal creek water belonged to a potential phosphorus-restricted eutrophication state. The RI result indicated that Cu and Pb in the water were at low ecological risk, while the SSD and RQ results indicated that Cu in the water was at a high ecological risk level and had potential harm to aquatic organisms. Based on the single-factor method, the water quality of the tidal creek inside and outside the Yellow River Delta Nature Reserve belonged to Grade IV. Cu should be controlled to improve the water quality and reduce the ecological risk, especially in the Yellow River Delta Nature Reserve