The Schwarzhorn Amphibolite (Eastern Ratikon, Austria): an Early Cambrian intrusion in the Lower Austroalpine basement

The Alpine nappe stack in the Penninic-Austroalpine boundary zone in the Ratikon (Austria) contains a 4x1 km tectonic sliver of meta-diorite, known as the Schwarzhorn Amphibolite. It was deformed and metamorphosed in the amphibolite facies and is unconformably overlain by unmetamorphic Lower Triassic sandstone, indicating pre-Triassic metamorphism. Cataclastic deformation and brecciation of the amphibolite is related to normal faulting and block tilting during Jurassic rifting. Zircon dating of the Schwarzhorn Amphibolite using LA-ICP-MS gave a U-Pb age of 529+9/-8 Ma, interpreted as the crystallization age of the protolith. Geochemical characteristics indicate formation of the magmatic protolith in a supra-subduction zone setting. The Cambrian protolith age identifies the Schwarzhorn Amphibolite as a pre-Variscan element within the Austroalpine basement. Similar calc-alkaline igneous rocks of Late Neoproterozoic to Early Cambrian age are found in the Upper Austroalpine Silvretta Nappe nearby and in several other Variscan basement units of the Alps, interpreted to have formed in a peri-Gondwanan active-margin or island-arc setting

The Schwarzhorn Amphibolite (Eastern Rätikon, Austria): an Early Cambrian intrusion in the Lower Austroalpine basement

The Alpine nappe stack in the Penninic-Austroalpine boundary zone in the Rätikon (Austria) contains a 4×1 km tectonic sliver of meta-diorite, known as the Schwarzhorn Amphibolite. It was deformed and metamorphosed in the amphibolite facies and is unconformably overlain by unmetamorphic Lower Triassic sandstone, indicating pre-Triassic metamorphism. Cataclastic deformation and brecciation of the amphibolite is related to normal faulting and block tilting during Jurassic rifting. Zircon dating of the Schwarzhorn Amphibolite using LA-ICP-MS gave a U-Pb age of 529+9/-8 Ma, interpreted as the crystallization age of the protolith. Geochemical characteristics indicate formation of the magmatic protolith in a supra-subduction zone setting. The Cambrian protolith age identifies the Schwarzhorn Amphibolite as a pre-Variscan element within the Austroalpine basement. Similar calc-alkaline igneous rocks of Late Neoproterozoic to Early Cambrian age are found in the Upper Austroalpine Silvretta Nappe nearby and in several other Variscan basement units of the Alps, interpreted to have formed in a peri-Gondwanan active-margin or island-arc setting

Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data

Background: Patients who have had a stroke with unknown time of onset have been previously excluded from thrombolysis. We aimed to establish whether intravenous alteplase is safe and effective in such patients when salvageable tissue has been identified with imaging biomarkers. Methods: We did a systematic review and meta-analysis of individual patient data for trials published before Sept 21, 2020. Randomised trials of intravenous alteplase versus standard of care or placebo in adults with stroke with unknown time of onset with perfusion-diffusion MRI, perfusion CT, or MRI with diffusion weighted imaging-fluid attenuated inversion recovery (DWI-FLAIR) mismatch were eligible. The primary outcome was favourable functional outcome (score of 0–1 on the modified Rankin Scale [mRS]) at 90 days indicating no disability using an unconditional mixed-effect logistic-regression model fitted to estimate the treatment effect. Secondary outcomes were mRS shift towards a better functional outcome and independent outcome (mRS 0–2) at 90 days. Safety outcomes included death, severe disability or death (mRS score 4–6), and symptomatic intracranial haemorrhage. This study is registered with PROSPERO, CRD42020166903. Findings: Of 249 identified abstracts, four trials met our eligibility criteria for inclusion: WAKE-UP, EXTEND, THAWS, and ECASS-4. The four trials provided individual patient data for 843 individuals, of whom 429 (51%) were assigned to alteplase and 414 (49%) to placebo or standard care. A favourable outcome occurred in 199 (47%) of 420 patients with alteplase and in 160 (39%) of 409 patients among controls (adjusted odds ratio [OR] 1·49 [95% CI 1·10–2·03]; p=0·011), with low heterogeneity across studies (I 2=27%). Alteplase was associated with a significant shift towards better functional outcome (adjusted common OR 1·38 [95% CI 1·05–1·80]; p=0·019), and a higher odds of independent outcome (adjusted OR 1·50 [1·06–2·12]; p=0·022). In the alteplase group, 90 (21%) patients were severely disabled or died (mRS score 4–6), compared with 102 (25%) patients in the control group (adjusted OR 0·76 [0·52–1·11]; p=0·15). 27 (6%) patients died in the alteplase group and 14 (3%) patients died among controls (adjusted OR 2·06 [1·03–4·09]; p=0·040). The prevalence of symptomatic intracranial haemorrhage was higher in the alteplase group than among controls (11 [3%] vs two [<1%], adjusted OR 5·58 [1·22–25·50]; p=0·024). Interpretation: In patients who have had a stroke with unknown time of onset with a DWI-FLAIR or perfusion mismatch, intravenous alteplase resulted in better functional outcome at 90 days than placebo or standard care. A net benefit was observed for all functional outcomes despite an increased risk of symptomatic intracranial haemorrhage. Although there were more deaths with alteplase than placebo, there were fewer cases of severe disability or death. Funding: None