Early Intubation in Endovascular Therapy for Basilar Artery Occlusion:A Post Hoc Analysis of the BASICS Trial

BACKGROUND: The optimal anesthetic management for endovascular therapy (EVT) in patients with posterior circulation stroke remains unclear. Our objective was to investigate the impact of early intubation in patients enrolled in the BASICS trial (Basilar Artery International Cooperation Study). METHODS: BASICS was a multicenter, randomized, controlled trial that compared the efficacy of EVT compared with the best medical care alone in patients with basilar artery occlusion. In this post hoc analysis, early intubation within the first 24 hours of the estimated time of basilar artery occlusion was examined as an additional covariate using regression modeling. We estimated the adjusted relative risks (RRs) for favorable outcomes, defined as modified Rankin Scale scores of 0 to 3 at 90 days. An adjusted common odds ratio was estimated for a shift in the distribution of modified Rankin Scale scores at 90 days. RESULTS: Of 300 patients in BASICS, 289 patients were eligible for analysis (151 in the EVT group and 138 in the best medical care group). compared with medical care alone, EVT was related to a higher risk of early intubation (RR, 1.29 [95% CI, 1.09–1.53]; P&lt;0.01), and early intubation was negatively associated with favorable outcome (RR, 0.61 [95% CI, 0.45–0.84]; P=0.002). Whereas there was no overall treatment effect of EVT on favorable outcome (RR, 1.22 [95% CI, 0.95–1.55]; P=0.121), EVT was associated with favorable outcome (RR, 1.34 [95% CI, 1.05–1.71]; P=0.018) and a shift toward lower modified Rankin Scale scores (adjusted common odds ratio, 1.63 [95% CI, 1.04–2.57]; P=0.033) if adjusted for early intubation. CONCLUSIONS: In this post hoc analysis of the neutral BASICS trial, early intubation was linked to unfavorable outcomes, which might mitigate a potential benefit from EVT by indirect effects due to an increased risk of early intubation. This relationship may be considered when assessing the efficacy of EVT in patients with basilar artery occlusion in future trials.</p

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans – anteaters, sloths, and armadillos – have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with 24 domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, ten anteaters, and six sloths. Our dataset includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data-paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the south of the USA, Mexico, and Caribbean countries at the northern portion of the Neotropics, to its austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n=5,941), and Cyclopes sp. has the fewest (n=240). The armadillo species with the most data is Dasypus novemcinctus (n=11,588), and the least recorded for Calyptophractus retusus (n=33). With regards to sloth species, Bradypus variegatus has the most records (n=962), and Bradypus pygmaeus has the fewest (n=12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other datasets of Neotropical Series which will become available very soon (i.e. Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans dataset

Consumo de forragem e produção de leite de vacas em pastagem de azevém-anual com duas ofertas de forragem Herbage intake and milk yield of dairy cows grazing Italian ryegrass at two herbage allowances

Avaliou-se o efeito de duas ofertas de forragem (25 e 40 kg MS/vaca.dia) sobre o consumo de forragem e a produção de leite em vacas pastejando azevém-anual. Utilizou-se o método rotacionado, em delineamento experimental de dupla reversão, com três períodos de 12 dias e dez vacas da raça Holandesa no terço médio de lactação. O consumo de forragem foi estimado pela produção fecal e pela digestibilidade da forragem ingerida e a produção de leite foi medida diariamente. A biomassa e a altura do dossel antes do pastejo não diferiram entre as ofertas de forragem. A altura pós-pastejo foi maior na oferta de forragem de 40 kg MS/vaca.dia, o que determinou desaparecimento de forragem equivalente a 49,0% nessa oferta de forragem e a 69,0% na oferta de 25 kg MS/vaca.dia. O consumo individual de matéria seca (MS) da forragem foi 11,9 e 16,6 kg/dia e a produção de leite, 18,4 e 21,1 kg/dia nas ofertas de 25 e 40 kg MS/vaca.dia, respectivamente. Vacas leiteiras em pastagem de azevém com alta oferta de forragem podem ingerir mais de 16,0 kg de MS e produzir mais de 20 kg de leite/dia. A produção de leite reduz aproximadamente 0,2 kg a cada kg de diminuição na MS de forragem oferecida.<br>The effect of two herbage allowances (25 and 40 kg dry matter/cow.day) were assessed on the herbage intake and milk yield of dairy cows grazing Italian ryegrass. A rotational grazing system was used, according to a Change Over procedure with three 12-day periods and ten Holstein cows in mid-lactation. Individual herbage intake was estimated from fecal output and the digestibility of the selected herbage and the milk yield was measured daily. Pre-grazing sward height and herbage mass at ground level did not differ between treatments. Post-grazing sward height was higher 40 kg dry matter/cow.day and the pasture disappearance rate from the initial sward was 49.0% and 69.0%, respectively. The individual dry matter intake of the herbage was 11.9 and 16.6 kg kg/day and the milk yield was 18.4 and. 21.1 kg/day at the allowances 25 and 40 kg dry matter/cow.day, respectively. Dairy cows grazing Italian ryegrass pasture, with a high forage allowance, can eat more than 16.0 kg DM/day and produce more than 20 kg milk/day. The milk yield decreased around 0.2 kg per kg of reduction in DM offer

Endovascular Therapy for Stroke Due to Basilar-Artery Occlusion.

The effectiveness of endovascular therapy in patients with stroke caused by basilar-artery occlusion has not been well studied. We randomly assigned patients within 6 hours after the estimated time of onset of a stroke due to basilar-artery occlusion, in a 1:1 ratio, to receive endovascular therapy or standard medical care. The primary outcome was a favorable functional outcome, defined as a score of 0 to 3 on the modified Rankin scale (range, 0 to 6, with 0 indicating no disability, 3 indicating moderate disability, and 6 indicating death) at 90 days. The primary safety outcomes were symptomatic intracranial hemorrhage within 3 days after the initiation of treatment and mortality at 90 days. A total of 300 patients were enrolled (154 in the endovascular therapy group and 146 in the medical care group). Intravenous thrombolysis was used in 78.6% of the patients in the endovascular group and in 79.5% of those in the medical group. Endovascular treatment was initiated at a median of 4.4 hours after stroke onset. A favorable functional outcome occurred in 68 of 154 patients (44.2%) in the endovascular group and 55 of 146 patients (37.7%) in the medical care group (risk ratio, 1.18; 95% confidence interval [CI], 0.92 to 1.50). Symptomatic intracranial hemorrhage occurred in 4.5% of the patients after endovascular therapy and in 0.7% of those after medical therapy (risk ratio, 6.9; 95% CI, 0.9 to 53.0); mortality at 90 days was 38.3% and 43.2%, respectively (risk ratio, 0.87; 95% CI, 0.68 to 1.12). Among patients with stroke from basilar-artery occlusion, endovascular therapy and medical therapy did not differ significantly with respect to a favorable functional outcome, but, as reflected by the wide confidence interval for the primary outcome, the results of this trial may not exclude a substantial benefit of endovascular therapy. Larger trials are needed to determine the efficacy and safety of endovascular therapy for basilar-artery occlusion. (Funded by the Dutch Heart Foundation and others; BASICS ClinicalTrials.gov number, NCT01717755; Netherlands Trial Register number, NL2500.)