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 (I2=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

The Use and Efficacy of Water Bottle Filling Stations as a Sustainability Initiative for Reducing Environmental Impact

My research examined how water bottle filling stations contribute to improving sustainability and reducing plastic waste at The University of Chicago (UChicago). A station inventory was created using information provided by Facilities Services and by visiting all campus buildings. To understand station usage, station meter (green ticker) data was recorded over a two-week period, a questionnaire was distributed to students, and station observations were conducted. It was found that filling stations are widely used and positively viewed by students. Cost-benefit analysis indicated that there is a large net benefit for installing additional filling stations at UChicago. Recommendations for further decreasing UChicago’s reliance on plastic water bottles and waste generation at minimal costs include improving filling station records, installing additional stations on campus, and reducing plastic water bottle sales and distribution. This research will assist UChicago in reducing its carbon footprint and serving as a model for other institutions to follow

Synthesis and characterization of an Al(69)(3-) cluster with 51 naked Al atoms: analogies and differences to the previously characterized Al(77)(2-) cluster

A disproportionation process of a metastable AlCl solution with a simultaneous ligand exchange-Cl is substituted by N(SiMe(3))(2)-leads to a [Al(69)[N(SiMe(3))(2)](18)](3-) cluster compound that can be regarded as an intermediate on the way to bulk metal formation. The cluster was characterized by an X-ray crystal structural analysis. Regarding its structure and the packing within the crystal, this metalloid cluster with 4 times more Al atoms than ligands is compared to the [Al(77)N(SiMe(3))(2)](20)](2-) cluster that has been published four years ago. Although there is a similar packing density of the Al atoms in both clusters as well as in Al metal, the X-ray structural analysis shows significant differences in topology and distance proportions. The differences between these-at a first glance almost identical-Al clusters demonstrate that results of physical measuring, e.g., of nanostructured surfaces which carry supposedly identical cluster species, have to be interpreted with great caution. [on SciFinder (R)

Are pit and fissure sealants needed in children with a higher caries risk?

The aim of this cross-sectional study was to analyse the preventive need of pit and fissure sealants (PFS) in a German population with a relatively high caries risk. The study involved 311 8- to 12-year-old children from the Ennepe-Ruhr District in North Rhine-Westphalia, Germany. Caries experience was scored according to WHO (1997) and ICDAS II criteria. PFS were assessed as intact or partially lost. The mean DFS values amounted to 0.5 for occlusal fissures, 0.2 for palatal/buccal pits and 0.3 for the remaining teeth. Non-cavitated caries lesions were recorded in average on 1.8 occlusal fissures and 1.5 palatal/buccal pits. Sealants were registered on 1.4 occlusal fissures and 0.4 palatal/buccal pits. The descriptive data and the adjusted Poisson regression models revealed that children with at least one fissure sealant are less likely to have decayed fissures or fissures with non-cavitated lesions on their permanent molars. Therefore, PFS are needed and indicated in caries-risk children

Sacral nerve stimulation for faecal incontinence in patients with previous partial spinal injury including disc prolapse

BACKGROUND: This study examined the use of sacral nerve stimulation (SNS) to treat faecal incontinence in patients with partial spinal injury. METHODS: Patients selected for SNS had experienced more than one episode of faecal incontinence per week to liquid or solid stool for more than 1 year and had failed maximal conservative treatment. All patients had an intact external anal sphincter. RESULTS: Temporary SNS was performed in 13 patients (median age 58.5 (range 39-73) years). The spinal insults were disc prolapse (six), trauma (four), spinal stenosis (one) or occurred during neurosurgery (two). Twelve patients (eight women and four men) had successful temporary stimulation and proceeded to permanent implantation. The median follow-up time was 12 (range 6-24) months. The mean(s.d.) number of episodes of incontinence decreased from 9.33(7.64) per week at baseline to 2.39(3.69) at last follow-up (P = 0.012). The number of days per week with incontinence and staining decreased significantly (both P < 0.001). Ability to defer defaecation improved from a median of not being able to defer (range 0-1 min) to being able to defer for 5-15 (range 0 to over 15) min (P = 0.022). CONCLUSION: SNS can benefit patients with faecal incontinence following partial spinal injury. Copyright (c) 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd