4 research outputs found

    Radial evolution of the April 2020 stealth coronal mass ejection between 0.8 and 1 AU. Comparison of Forbush decreases at Solar Orbiter and near the Earth

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    Aims. We present observations of the first coronal mass ejection (CME) observed at the Solar Orbiter spacecraft on April 19, 2020, and the associated Forbush decrease (FD) measured by its High Energy Telescope (HET). This CME is a multispacecraft event also seen near Earth the next day. Methods. We highlight the capabilities of HET for observing small short-term variations of the galactic cosmic ray count rate using its single detector counters. The analytical ForbMod model is applied to the FD measurements to reproduce the Forbush decrease at both locations. Input parameters for the model are derived from both in situ and remote-sensing observations of the CME. Results. The very slow (~350 km/s) stealth CME caused a FD with an amplitude of 3 % in the low-energy cosmic ray measurements at HET and 2 % in a comparable channel of the Cosmic Ray Telescope for the Effects of Radiation (CRaTER) on the Lunar Reconnaissance Orbiter, as well as a 1 % decrease in neutron monitor measurements. Significant differences are observed in the expansion behavior of the CME at different locations, which may be related to influence of the following high speed solar wind stream. Under certain assumptions, ForbMod is able to reproduce the observed FDs in low-energy cosmic ray measurements from HET as well as CRaTER, but with the same input parameters, the results do not agree with the FD amplitudes at higher energies measured by neutron monitors on Earth. We study these discrepancies and provide possible explanations. Conclusions. This study highlights that the novel measurements of the Solar Orbiter can be coordinated with other spacecraft to improve our understanding of space weather in the inner heliosphere. Multi-spacecraft observations combined with data-based modeling are also essential to understand the propagation and evolution of CMEs as well as their space weather impacts.Comment: accepted for publication in Astronomy & Astrophysic

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

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    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
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