Endovascular Therapy vs Medical Management for Patients With Acute Stroke With Medium Vessel Occlusion in the Anterior Circulation

Importance Randomized clinical trials have shown the efficacy of endovascular therapy (EVT) for acute large vessel occlusion strokes. The benefit of EVT in acute stroke with distal, medium vessel occlusion (DMVO) remains unclear. Objective To examine the efficacy and safety outcomes associated with EVT in patients with primary DMVO stroke when compared with a control cohort treated with medical management (MM) alone. Design, Setting, and Participants This multicenter, retrospective cohort study pooled data from patients who had an acute stroke and a primary anterior circulation emergency DMVO, defined as any segment of the anterior cerebral artery (ACA) or distal middle cerebral artery, between January 1, 2015, and December 31, 2019. Those with a concomitant proximal occlusion were excluded. Outcomes were compared between the 2 treatment groups using propensity score methods. Data analysis was performed from March to June 2021. Exposures Patients were divided into EVT and MM groups. Main Outcomes and Measures Main efficacy outcomes included 3-month functional independence (modified Rankin Scale [mRS] scores, 0-2) and 3-month excellent outcome (mRS scores, 0-1). Safety outcomes included 3-month mortality and symptomatic intracranial hemorrhage. Results A total of 286 patients with DMVO were evaluated, including 156 treated with EVT (mean [SD] age, 66.7 [13.7] years; 90 men [57.6%]; median National Institute of Health Stroke Scale [NIHSS] score, 13.5 [IQR, 8.5-18.5]; intravenous tissue plasminogen activator [IV tPA] use, 75 [49.7%]; ACA involvement, 49 [31.4%]) and 130 treated with medical management (mean [SD] age, 69.8 [14.9] years; 62 men [47.7%]; median NIHSS score, 7.0 [IQR, 4.0-14.0], IV tPA use, 58 [44.6%]; ACA involvement, 31 [24.0%]). There was no difference in the unadjusted rate of 3-month functional independence in the EVT vs MM groups (151 [51.7%] vs 124 [50.0%]; P = .78), excellent outcome (151 [38.4%] vs 123 [31.7%]; P = .25), or mortality (139 [18.7%] vs 106 [11.3%]; P = .15). The rate of symptomatic intracranial hemorrhage was similar in the EVT vs MM groups (weighted: 4.0% vs 3.1%; P = .90). In inverse probability of treatment weighting propensity analyses, there was no significant difference between groups for functional independence (adjusted odds ratio [aOR], 1.36; 95% CI, 0.84-2.19; P = .20) or mortality (aOR, 1.24; 95% CI, 0.63-2.43; P = .53), whereas the EVT group had higher odds of an excellent outcome (mRS scores, 0-1) at 3 months (aOR, 1.71; 95% CI, 1.02-2.87; P = .04). Conclusions and Relevance The findings of this multicenter cohort study suggest that EVT may be considered for selected patients with ACA or distal middle cerebral artery strokes. Further larger randomized investigation regarding the risk-benefit ratio for DMVO treatment is indicated

An analysis of fixed dose IV recombinant tissue plasminogen activator (rtPA) and clinical outcomes in acute ischemic stroke patients with body weight \u3e100 kilograms: pooled data from three randomized clinical trials

BACKGROUND: The ASA/AHA guidelines recommend a fixed dose of 90 mg of intravenous recombinant tissue plasminogen activator (rt-PA) for acute stroke patients weighing more than 100 kilograms (kg). Previous analyses in small studies have suggested that the magnitude of benefit with IV rt-PA is lower in patients with body weight \u3e100 kg. We determined if body weight \u3e100 kg (and receiving \u3c0.9 mg/kg dose) independently influence patient clinical outcomes following IV rt-PA treatment. METHODS: We pooled data from IV rt-PA treatment arms from 3 randomized controlled trials; National Institutes of Neurological Disorders and Stroke (NINDS) IV tPA study, Interventional Management of Stroke 3 trial (IMS-III) and Albumin Treatment of Acute Ischemic Stroke (ALIAS part 1 and 2). Patients demographic, stroke severity, comorbidities, hospital outcome and 90-day modified Rankin Scale (mRS) were compared between patients \u3e100 kg and those ≤100 kg body weight (defined by estimated weight). Multivariate logistic regression model was used to identify independent effect of \u3e100 kg body weight on 90-day favorable outcome (defined as mRS 0-2). An ordinal analysis of the mRS was also performed. RESULTS: Among 977 patients treated with IV rt-PA, total of 111 subjects had body weight \u3e100 kg (11% of all patients). The mean age (±SD) for the patients with weight \u3e100 Kg was significantly lower (60±11 versus 68±13, p\u3c0.0001). The median admission National Institutes of Health Stroke Scale (NIHSS) score was not different between the two groups (12 versus 13, p=0.08). Patients with weight \u3e100 kg had higher rates of history of hypertension, diabetes mellitus, and hyperlipidemia. Patients with body weight \u3e100 kg had longer period (days±SD) of hospitalization (11±14 versus 8±7, p=0.04). Compared with patients with ≤100 kg body weight, the rate of favorable outcome at 90 days was not significantly different among patients with \u3e100 kg body weight [OR; (95% CI): 0.99 (0.91-1.04)p=0.91, after adjusting for potential confounders. The ordinal analysis did not showed any significant shift in the distribution of scores on the mRS in patients with \u3e100 kg body weight (OR, 0.93; 95% CI, 0.64 to 1.37; P = 0.74) CONCLUSION: Body weight \u3e100 kg (and receiving \u3c0.9 mg/kg dose) did not reduce the benefit of IV rt-PA treatment in acute ischemic stroke patients. Our results support the current recommendations in the ASA/AHA guidelines

Assessment of nanopolyamidoamine-G7 dendrimer antibacterial effect in aqueous solution

Background: Poly(amidoamine) (PAMAM) dendrimer derivatives have been investigated for their biological applications, especially for delivery of drugs, including antimicrobial drugs to eukaryotic cells, but their effects on bacterial cells are largely unexplored. Nanotechnology and its application is one of the rapidly developing sciences. As demand of fresh drinking water is increasing, nanotechnology can contribute noticeable development and improvement to water treatment process. This study was aimed to examine synthesis and the antibacterial effect of Nanopolyamidoamine-G7 (NPAMAM-G7) dendrimer on Escherichia Coli (E. Coli), Klebsiella Oxytoca (K. Oxytoca), Pseudomonas Aeruginosa (P. Aeruginosa), Proteus Mirabilis (P. Mirabilis) and Staphylococcus Aureus (S. Aureus) from aqueous solution. Methods: In this experimental study that has been conducted in August to December 2015 in the laboratory of microbiology of Iran University of Medical Sciences, initially dilution of 103 CFU/ml were prepared from each strain of bacteria. Then different concentrations of dendrimer (0.025, 0.25, 2.5 and 25 µg/ml) in the laboratory temperature (23-25 °C) was added to water. In order to determine the efficiency of dendrimers in removal of bacteria, samples were taken at different times (0, 10, 20, 30, 40, 50 and 60 min) and were cultured on nutrient agar medium. Samples were incubated for 24 hours at 37 °C and then number of colonies were counted. Results: Antibacterial properties of dendrimers in aqueous solution by increasing the dendrimer concentration and contact time is directly related. At a concentration of 25 μg/ml at 60 minutes all bacteria except S. Aureus, and at 30 minutes, E. Coli and K. Oxytoca bacteria for 100% excluded. The concentration of 2.5 μg/ml at 60 minutes of bacteria, E. Coli, K. Oxytoca and P. Mirabilis are 100% excluded. All concentrations of dendrimers at different times were reduced bacteria in the PAMAM- G7 dendrimer effect on gram-negative bacteria, gram-positive bacteria was better. Conclusion: The NPAMAM-G7 dendrimer with end amine groups exhibited a positive impact on the removal of standard strains, gram-positive and gram-negative bacteria. Therefore, it is possible to use these nanodendrimers as antibacterial in the future

Effect of maternal nitrogen and drought stress on seed dormancy and germinability of Amaranthus retroflexus

Amaranthus retroflexus L. is an importunate annual weed in many cropping systems of different countries. The main aim of this study was to investigate the effects of maternal nitrogen and drought stress on the seed dormancy and germinability of A. retroflexus. Field experiment was carried out in a factorial based on randomized complete block design, with four potential levels of soil water (-2, -6, -8 and -10 bar) and three levels of nitrogen (0, 100 and 200 kg/ha). The germination characteristics of the seeds were measured at three different times (1 month, 6 months and 1 year after harvesting). Results showed that drought stress had positive effects on breaking of A. retroflexus seed dormancy until 6 months after seed harvesting. Seeds that were developed under severe water stress exhibited the highest germination percentage and germination rate. The results obtained from this study revealed that application of 100 kg/ha nitrogen during seed development increases germinability of A. retroflexus, whereas application of 200 kg/ha nitrogen induced seed dormancy. Furthermore, 100 kg/ha nitrogen application in the field along with 200 ppm gibberellic-acid treatment during seed after-ripening showed the highest germination percentage and germination rate for seeds after 6 months harvesting. Results also indicated that after-ripening significantly increased seed germination and germination rate of A. retroflexus. These findings indicate that long-term management of the soil seed bank in this species requires more stringent control due to the changes in germination timing, as detected in this study