850 research outputs found
Tenecteplase for the treatment of acute ischemic stroke: a review of completed and ongoing randomized controlled trials
Alteplase has been the mainstay of thrombolytic treatment since the National Institutes of Neurological Disorders and
Stroke trial was published in 1995. Over recent years, several trials have investigated alternative thrombolytic agents.
Tenecteplase, a genetically engineered mutant tissue plasminogen activator, has a longer half-life, allowing single intravenous
bolus administration without infusion, is more fibrin specific, produces less systemic depletion of circulating
fibrinogen, and is more resistant to plasminogen activator inhibitor compared to alteplase. Tenecteplase is established as
the first-line intravenous thrombolytic drug for myocardial infarction, where it has been shown to achieve comparable
reperfusion with reduced risk of systemic bleeding in comparison to alteplase. We review the literature on tenecteplase
for the treatment of acute ischemic stroke, with a focus on the major completed and ongoing trials. Overall, tenecteplase
shows promise for treatment of acute ischemic stroke, both in populations currently eligible for alteplase and also in
groups not currently treated with thrombolysis
The Geodynamic Significance of Continental UHP Exhumation: new Constraints From the Tso Morari Complex, NW Himalaya
The burial and exhumation of continental crust to and from ultrahigh-pressure (UHP) is an important orogenic process, often interpreted with respect to the onset and/or subduction dynamics of continent-continent collision. Here, we investigate the timing and significance of UHP metamorphism and exhumation of the Tso Morari complex, North-West Himalaya. We present new petrochronological analyses of mafic eclogites and their host-rock gneisses, combining U-Pb zircon, rutile and xenotime geochronology (high-precision CA-ID-TIMS and high-spatial resolution LA-ICP-MS), garnet element maps, and petrographic observations. Zircon from mafic eclogite have a CA-ID-TIMS age of 46.91 ± 0.07 Ma, with REE profiles indicative of growth at eclogite facies conditions. Those ages overlap with zircon rim ages (48.9 ± 1.2 Ma, LA-ICP-MS) and xenotime ages (47.4 ± 1.4 Ma; LA-ICP-MS) from the hosting Puga gneiss, which grew during breakdown of UHP garnet rims. We argue that peak zircon growth at 47–46 Ma corresponds to the onset of exhumation from UHP conditions. Subsequent exhumation through the rutile closure temperature, is constrained by new dates of 40.4 ± 1.7 and 36.3 ± 3.8 Ma (LA-ICP-MS). Overlapping ages from Kaghan imply a coeval time-frame for the onset of UHP exhumation across the NW Himalaya. Furthermore, our regional synthesis demonstrates a causative link between changes in the subduction dynamics of the India-Asia collision zone at 47–46 Ma and the resulting mid-Eocene plate network reorganization. The onset of UHP exhumation therefore provides a tightly constrained time-stamp significant geodynamic shifts within the orogen and wider plate network
The CCD instrument background of the SMILE SXI
The ESA and CAS SMILE mission orbit is highly elliptical and will pass through multiple radiation environments. The Soft X-ray Imager (SXI) instrument aboard has a radiation shutter door designed to close when the surrounding radiation flux is high. The shutter door will close when passing below an altitude threshold to protect against trapped particles in the Earth’s Van Allen Belts. Therefore, two radiation environments can be approximated based on the shutter door position: open and closed. The instrument background for the CCDs (Charge-Coupled Devices) that form the focal plane array of the SXI were evaluated for the two environments. Due to the correlation of the space environment with the solar cycle, the solar minima and maxima, the background was also evaluated at these two extremes. The results demonstrated that the highest instrument background will occur during solar minima due to the main contributing source being Galactic Cosmic Rays (GCRs). It was also found that the open background was highest for solar minima and that the closed background was highest during solar maxima. This is due to the radiation shutter door acting as a scattering centre and the changes in the energy flux distribution of the GCRs between the two solar extremes
Intravenous thrombolysis may not improve clinical outcome of acute ischemic stroke patients without a baseline vessel occlusion
Background and Purpose: The benefit of thrombolysis in ischemic stroke patients without a visible vessel occlusion still requires investigation. This study tested the hypothesis that non-lacunar stroke patients with no visible vessel occlusion on baseline imaging would have a favorable outcome regardless of treatment with alteplase. Methods: We utilized a prospectively collected registry of ischemic stroke patients [the International Stroke Perfusion Imaging Registry (INSPIRE)] who had baseline computed tomographic perfusion and computed tomographic angiography. The rates of patients achieving modified Rankin Scale (mRS) 0-1 were compared between alteplase treated and untreated patients using logistic regression to generate odds ratios. Results: Of 1569 patients in the INSPIRE registry, 1,277 were eligible for inclusion. Of these, 306 (24%) had no identifiable occlusion and were eligible for alteplase, with 141 (46%) of these patients receiving thrombolysis. The treated and untreated groups had significantly different median baseline National Institutes of Health Stroke Scale (NIHSS) [alteplase 8, interquartile range (IQR) 5-10, untreated 6, IQR 4-8, P < 0.001] and median volume of baseline perfusion lesion [alteplase 5.6 mL, IQR 1.3-17.7 mL, untreated 2.6 mL, IQR 0-6.7 mL, P < 0.001]. After propensity analysis, alteplase treated patients without a vessel occlusion were less likely to have an excellent outcome (mRS 0-1; 56%) than untreated (78.8%, OR, 0.42, 95% confidence interval, 0.24-0.75, P = 0.003). Conclusions: In this non-randomized comparison, alteplase treatment in patients without an identifiable vessel occlusion did not result in higher rates of favorable outcome compared to untreated. However, treated patients displayed less favorable baseline prognostic factors than the untreated group. Further studies may be required to confirm this data.Huiqiao Tian, Mark W. Parsons, Christopher R. Levi, Xin Cheng, Richard I. Aviv, Neil J. Spratt, Timothy J. Kleinig, Billy O'Brien, Kenneth S. Butcher, Longting Lin, Jingfen Zhang, Qiang Dong, Chushuang Chen and Andrew Bivar
Developing a multivariable prediction model for functional outcome after reperfusion therapy for acute ischaemic stroke: study protocol for the Targeting Optimal Thrombolysis Outcomes (TOTO) multicentre cohort study
INTRODUCTION: Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) is the only approved pharmacological reperfusion therapy for acute ischaemic stroke. Despite population benefit, IVT is not equally effective in all patients, nor is it without significant risk. Uncertain treatment outcome prediction complicates patient treatment selection. This study will develop and validate predictive algorithms for IVT response, using clinical, radiological and blood-based biomarker measures. A secondary objective is to develop predictive algorithms for endovascular thrombectomy (EVT), which has been proven as an effective reperfusion therapy since study inception. METHODS AND ANALYSIS: The Targeting Optimal Thrombolysis Outcomes Study is a multicenter prospective cohort study of ischaemic stroke patients treated at participating Australian Stroke Centres with IVT and/or EVT. Patients undergo neuroimaging using multimodal CT or MRI at baseline with repeat neuroimaging 24 hours post-treatment. Baseline and follow-up blood samples are provided for research use. The primary outcome is good functional outcome at 90 days poststroke, defined as a modified Rankin Scale (mRS) Score of 0-2. Secondary outcomes are reperfusion, recanalisation, infarct core growth, change in stroke severity, poor functional outcome, excellent functional outcome and ordinal mRS at 90 days. Primary predictive models will be developed and validated in patients treated only with rt-PA. Models will be built using regression methods and include clinical variables, radiological measures from multimodal neuroimaging and blood-based biomarkers measured by mass spectrometry. Predictive accuracy will be quantified using c-statistics and R2. In secondary analyses, models will be developed in patients treated using EVT, with or without prior IVT, reflecting practice changes since original study design. ETHICS AND DISSEMINATION: Patients, or relatives when patients could not consent, provide written informed consent to participate. This study received approval from the Hunter New England Local Health District Human Research Ethics Committee (reference 14/10/15/4.02). Findings will be disseminated via peer-reviewed publications and conference presentations.Elizabeth Holliday ... Marten Snel ... Simon Koblar ... Monica Hamilton-Bruce ... Timothy Kleinig ... Paul J Trim ... et al
Search for Higgs bosons decaying to tautau pairs in ppbar collisions at sqrt(s) = 1.96 TeV
We present a search for the production of neutral Higgs bosons decaying into
tautau pairs in ppbar collisions at a center-of-mass energy of 1.96 TeV. The
data, corresponding to an integrated luminosity of 5.4 fb-1, were collected by
the D0 experiment at the Fermilab Tevatron Collider. We set upper limits at the
95% C.L. on the product of production cross section and branching ratio for a
scalar resonance decaying into tautau pairs, and we then interpret these limits
as limits on the production of Higgs bosons in the minimal supersymmetric
standard model (MSSM) and as constraints in the MSSM parameter space.Comment: 7 pages, 5 figures, submitted to PL
Measurement of three-jet differential cross sections d sigma-3jet / d M-3jet in p anti-p collisions at sqrt(s)=1.96 TeV
We present the first measurement of the inclusive three-jet differential
cross section as a function of the invariant mass of the three jets with the
largest transverse momenta in an event in p anti-p collisions at sqrt(s) = 1.96
TeV. The measurement is made in different rapidity regions and for different
jet transverse momentum requirements and is based on a data set corresponding
to an integrated luminosity of 0.7 fb^{-1} collected with the D0 detector at
the Fermilab Tevatron Collider. The results are used to test the three-jet
matrix elements in perturbative QCD calculations at next-to-leading order in
the strong coupling constant. The data allow discrimination between
parametrizations of the parton distribution functions of the proton.Comment: 10 pages, 4 figures, 2 tables, submitted to Phys. Lett. B, corrected
chi2 values for NNPD
Measurements of inclusive W+jets production rates as a function of jet transverse momentum in ppbar collisions at sqrt{s}=1.96 TeV
This Letter describes measurements of inclusive W (--> e nu) + n jet cross
sections (n = 1-4), presented as total inclusive cross sections and
differentially in the nth jet transverse momentum. The measurements are made
using data corresponding to an integrated luminosity of 4.2 fb-1 collected by
the D0 detector at the Fermilab Tevatron Collider, and achieve considerably
smaller uncertainties on W +jets production cross sections than previous
measurements. The measurements are compared to next-to-leading order
perturbative QCD (pQCD) calculations in the n =1-3 jet multiplicity bins and to
leading order pQCD calculations in the 4-jet bin. The measurements are
generally in agreement with pQCD predictions, although certain regions of phase
space are identified where the calculations could be improved
Measurement of spin correlation in ttbar production using dilepton final states
We measure the correlation between the spin of the top quark and the spin of
the anti-top quark in (ttbar -> W+ W- b bbar -> l+ nu b l- nubar bbar) final
states produced in ppbar collisions at a center of mass energy sqrt(s)=1.96
TeV, where l is an electron or muon. The data correspond to an integrated
luminosity of 5.4 fb-1 and were collected with the D0 detector at the Fermilab
Tevatron collider. The correlation is extracted from the angles of the two
leptons in the t and tbar rest frames, yielding a correlation strength C=
0.10^{+0.45}_{-0.45}, in agreement with the NLO QCD prediction within two
standard deviations, but also in agreement with the no correlation hypothesis.Comment: 10 pages, 3 figures, submitted to PL
Search for single top quarks in the tau+jets channel using 4.8 fb of collision data
We present the first direct search for single top quark production using tau
leptons. The search is based on 4.8 fb of integrated luminosity
collected in collisions at =1.96 TeV with the D0 detector
at the Fermilab Tevatron Collider. We select events with a final state
including an isolated tau lepton, missing transverse energy, two or three jets,
one or two of them tagged. We use a multivariate technique to discriminate
signal from background. The number of events observed in data in this final
state is consistent with the signal plus background expectation. We set in the
tau+jets channel an upper limit on the single top quark cross section of
\TauLimObs pb at the 95% C.L. This measurement allows a gain of 4% in expected
sensitivity for the observation of single top production when combining it with
electron+jets and muon+jets channels already published by the D0 collaboration
with 2.3 fb of data. We measure a combined cross section of
\SuperCombineXSall pb, which is the most precise measurement to date.Comment: 12 pages, 5 figure
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