Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Sustainability assessment of electricity generation technologies: a transition pathway for Pakistan

Sustainable electricity generation is at the pole position for global sustainable development. The purpose of this research is to develop a systematic framework for assessing sustainability of different electricity generation technologies, and present its application on Pakistan, which is a region with research gaps. Hydro and oil with a sustainability impact score of 0.59 and 0.39, respectively, were identified as the top and bottom sustainability performers. Gas, solar PV, wind, and coal scored 0.54, 0.52, 0.52, and 0.42, respectively. Gas is suggested as a bridging fuel for transition to a 100% renewable energy scenario by 2050. Contributions include formulation of a holistic electric generation sustainability assessment approach, and a sustainable transition pathway for Pakistan region to guide future policy making

Laser induced graphite plasma kinetic spectroscopy under different ambient pressures

In this study, graphite laser induced plasma dynamics are investigated by optical emission spectroscopy. Graphite plasma is generated using a 1064 nm Nd:YAG laser in helium environment under different ambient pressures. Characteristics of graphite spectra as lines intensity variations and signal to noise ratio are presented with main focus on the influence of the helium environment and pressure on plasma dynamics. Carbon atomic emission lines are used to study the dynamical behavior of plasma such as the excitation temperature and electron density to describe emission differences in different ambient conditions. The excitation temperature and plasma electron density are the primary factor contribute to the differences among the atomic carbon emission in different ambient pressures

Drop-shaped fractal patch antenna for THz applications

In this paper, a drop-shaped fractal patch antenna is designed and simulated using Polyamide substrate. The designed antenna is simulated for 4.35–4.42 THz. The designed antenna resonates at 4.4 THz frequency. The maximum gain of 9.34 dBi is achieved. The designed antenna has applications in THz for communication, sensing, and 4.2, 4.3, and 4.4 THz frequency is used for quantum cascade laser. The proposed antenna is designed using CST software

Classification of ECG ventricular beats assisted by Gaussian parameters’ dictionary

Automatic processing and diagnosis of electrocardiogram (ECG) signals remain a very challenging problem, especially with the growth of advanced monitoring technologies. A particular task in ECG processing that has received tremendous attention is to detect and identify pathological heartbeats, e.g., those caused by premature ventricular contraction (PVC). This paper aims to build on the existing methods of heartbeat classification and introduce a new approach to detect ventricular beats using a dictionary of Gaussian-based parameters that model ECG signals. The proposed approach relies on new techniques to segment the stream of ECG signals and automatically cluster the beats for each patient. Two benchmark datasets have been used to evaluate the classification performance, namely, the QTDB and MIT-BIH Arrhythmia databases, based on a single lead short ECG segment. Using the QTDB database, the method achieved the average accuracies of 99.3% ± 0.7 and 99.4% ± 0.6% for lead-1 and lead-2, respectively. On the other hand, identifying ventricular beats in the MIT-BIH Arrhythmia dataset resulted in a sensitivity of 82.8%, a positive predictivity of 62.0%, and F1 score of 70.9%. For non-ventricular beats, the method achieved a sensitivity of 96.0%, a positive predictivity of 98.6%, and F1 score of 97.3%. The proposed technique represents an improvement in the field of ventricular beat classification compared with the conventional methods

A brief review of computation techniques for ECG signal analysis

Automatic detection of life-threatening cardiac arrhythmias has been a subject of interest for many decades. The automatic ECG signal analysis methods are mainly aiming for the interpretation of long-term ECG recordings. In fact, the experienced cardiologists perform the ECG analysis using a strip of ECG graph paper in an event-by-event manner. This manual interpretation becomes more difficult, time-consuming, and more tedious when dealing with long-term ECG recordings. Rather, an automatic computerized ECG analysis system will provide valuable assistance to the cardiologists to deliver fast or remote medical advice and diagnosis to the patient. However, achieving accurate automated arrhythmia diagnosis is a challenging task that has to account for all the ECG characteristics and processing steps. Detecting the P wave, QRS complex, and T wave is crucial to perform automatic analysis of EEG signals. Most of the research in this area uses the QRS complex as it is the easiest symbol to detect in the first stage. The QRS complex represents ventricular depolarization and consists of three consequences waves. However, the main challenge in any algorithm design is the large variation of QRS, P, and T waveform, leading to failure for each method. The QRS complex may only occupy R waves QR (no R), QR (no S), S (no Q), or RSR, depending on the ECG lead. Variations from the normal electrical patterns can indicate damage to the heart, and these variations are manifested as heart attack or heart disease. This paper will discuss the most recent and relevant methods related to each sub-stage, maintaining the related literature to the scope of ECG research

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

BackgroundTranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding.MethodsWe did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124.FindingsBetween July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98).InterpretationWe found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial.</div