Effects of alteplase for acute stroke according to criteria defining the European Union and United States marketing authorizations: individual-patient-data meta-analysis of randomized trials

Background: The recommended maximum age and time window for intravenous alteplase treatment of acute ischemic stroke differs between the Europe Union and United States. Aims: We compared the effects of alteplase in cohorts defined by the current Europe Union or United States marketing approval labels, and by hypothetical revisions of the labels that would remove the Europe Union upper age limit or extend the United States treatment time window to 4.5 h. Methods: We assessed outcomes in an individual-patient-data meta-analysis of eight randomized trials of intravenous alteplase (0.9 mg/kg) versus control for acute ischemic stroke. Outcomes included: excellent outcome (modified Rankin score 0–1) at 3–6 months, the distribution of modified Rankin score, symptomatic intracerebral hemorrhage, and 90-day mortality. Results: Alteplase increased the odds of modified Rankin score 0–1 among 2449/6136 (40%) patients who met the current European Union label and 3491 (57%) patients who met the age-revised label (odds ratio 1.42, 95% CI 1.21−1.68 and 1.43, 1.23−1.65, respectively), but not in those outside the age-revised label (1.06, 0.90−1.26). By 90 days, there was no increased mortality in the current and age-revised cohorts (hazard ratios 0.98, 95% CI 0.76−1.25 and 1.01, 0.86–1.19, respectively) but mortality remained higher outside the age-revised label (1.19, 0.99–1.42). Similarly, alteplase increased the odds of modified Rankin score 0-1 among 1174/6136 (19%) patients who met the current US approval and 3326 (54%) who met a 4.5-h revised approval (odds ratio 1.55, 1.19−2.01 and 1.37, 1.17−1.59, respectively), but not for those outside the 4.5-h revised approval (1.14, 0.97−1.34). By 90 days, no increased mortality remained for the current and 4.5-h revised label cohorts (hazard ratios 0.99, 0.77−1.26 and 1.02, 0.87–1.20, respectively) but mortality remained higher outside the 4.5-h revised approval (1.17, 0.98–1.41). Conclusions: An age-revised European Union label or 4.5-h-revised United States label would each increase the number of patients deriving net benefit from alteplase by 90 days after acute ischemic stroke, without excess mortality

Leveraging High Resolution Signalized Intersection Data to Characterize Discharge Headway Distributions and Saturation Flow Rate Reliability

As highway systems become more congested, it becomes increasingly important to understand the reliability with which we can estimate important performance measures such as volume to capacity ratios, particularly as we move toward leveraging field infrastructure to obtain real-time performance measures. In 1947, Greenshields wrote a paper that characterized “green time consumed” by “car-in-line-number” that ultimately was called headway. Average headway is one of principles used by the highway capacity manual to estimate saturation flow rate at signalized intersections. However, the current analytical techniques calculate a deterministic value for saturation flow rate that does not consider the stochastic variation of saturation flow rate. This paper reviews techniques used to estimate saturation flow rate, and proposes enhanced calculation methods to group saturation flow rate estimates by queue length. Grouping saturation flow rate estimates by queue length provides a convenient framework to evaluate saturation flow rate reliability. The inter-quartile range (25% - 75%) of saturation flow rates was calculated to be 1000vph based on Greenshields’ calculation techniques. Using the proposed enhanced calculation characterizing saturation flow rate, the inter-quartile range of saturation flow rate was shown to decrease from approximately 400 vph with 5 cars in a queue to 300 vph with 10 cars in queue. Because saturation flow rate is a fundamental input to volume-to-capacity performance measures, characterizing the stochastic variation of saturation flow rates provides a basic input for assessing how reliably one can estimate important performance measures such as volume-to-capacity ratios, as well as other performance measures that build upon volume-to-capacity ratios

Precision measurement of CPCP violation in Bs0→J/ψK+K−B_s^0 \to J/\psi K^+K^- decays

The time-dependent $CP$ asymmetry in $B_s^0 \to J/\psi K^+K^-$ decays is measured using $pp$ collision data, corresponding to an integrated luminosity of $3.0$fb$^{-1}$, collected with the LHCb detector at centre-of-mass energies of $7$ and $8$TeV. In a sample of 96 000 $B_s^0 \to J/\psi K^+K^-$ decays, the $CP$-violating phase $\phi_s$ is measured, as well as the decay widths $\Gamma_{L}$ and $\Gamma_{H}$ of the light and heavy mass eigenstates of the $B_s^0-\bar{B}_s^0$ system. The values obtained are $\phi_s = -0.058 \pm 0.049 \pm 0.006$ rad, $\Gamma_s \equiv (\Gamma_{L}+\Gamma_{H})/2 = 0.6603 \pm 0.0027 \pm 0.0015$ps$^{-1}$, and$\Delta\Gamma_s \equiv \Gamma_{L} - \Gamma_{H} = 0.0805 \pm 0.0091 \pm 0.0032$ps$^{-1}$, where the first uncertainty is statistical and the second systematic. These are the most precise single measurements of those quantities to date. A combined analysis with $B_s^{0} \to J/\psi \pi^+\pi^-$ decays gives $\phi_s = -0.010 \pm 0.039$rad. All measurements are in agreement with the Standard Model predictions. For the first time the phase $\phi_s$ is measured independently for each polarisation state of the $K^+K^-$ system and shows no evidence for polarisation dependence.Comment: 6 figure

Dark energy survey year 1 results: curved-sky weak lensing mass map

We construct the largest curved-sky galaxy weak lensing mass map to date from the DES first-year (DES Y1) data. The map, about 10 times larger than the previous work, is constructed over a contiguous ≈1500 deg2, covering a comoving volume of ≈10 Gpc3. The effects of masking, sampling, and noise are tested using simulations. We generate weak lensing maps from two DES Y1 shear catalogues, METACALIBRATION and IM3SHAPE, with sources at redshift 0.2 < z < 1.3, and in each of four bins in this range. In the highest signal-to-noise map, the ratio between the mean signal to noise in the E-mode map and the B-mode map is ∼1.5 (∼2) when smoothed with a Gaussian filter of σG = 30 (80) arcmin. The second and third moments of the convergence κ in the maps are in agreement with simulations. We also find no significant correlation of κ with maps of potential systematic contaminants. Finally, we demonstrate two applications of the mass maps: (1) cross-correlation with different foreground tracers of mass and (2) exploration of the largest peaks and voids in the maps

Studying the ultraviolet spectrum of the first spectroscopically confirmed supernova at redshift two

We present observations of DES16C2nm, the first spectroscopically confirmed hydrogen-free superluminous supernova (SLSN-I) at redshift z » 2. DES16C2nm was discovered by the Dark Energy Survey (DES) Supernova Program, with follow-up photometric data from the Hubble Space Telescope, Gemini, and the European Southern Observatory Very Large Telescope supplementing the DES data. Spectroscopic observations confirm DES16C2nm to be at z = 1.998, and spectroscopically similar to Gaia16apd (a SLSN-I at z = 0.102), with a peak absolute magnitude of U =- 22.26 0.06. The high redshift of DES16C2nm provides a unique opportunity to study the ultraviolet (UV) properties of SLSNe-I. Combining DES16C2nm with 10 similar events from the literature, we show that there exists a homogeneous class of SLSNe-I in the UV (lrest » 2500 Å), with peak luminosities in the (rest-frame) U band, and increasing absorption to shorter wavelengths. There is no evidence that the mean photometric and spectroscopic properties of SLSNe-I differ between low (z 1), but there is clear evidence of diversity in the spectrum at lrest 2 these events appear optically red, peaking in the observer-frame z-band. Such characteristics are critical to identify these objects with future facilities such as the Large Synoptic Survey Telescope, Euclid, and the Wide-field Infrared Survey Telescope, which should detect such SLSNe-I to z = 3.5, 3.7, and 6.6, respectively

Phenotypic Characterization of EIF2AK4 Mutation Carriers in a Large Cohort of Patients Diagnosed Clinically With Pulmonary Arterial Hypertension.

BACKGROUND: Pulmonary arterial hypertension (PAH) is a rare disease with an emerging genetic basis. Heterozygous mutations in the gene encoding the bone morphogenetic protein receptor type 2 (BMPR2) are the commonest genetic cause of PAH, whereas biallelic mutations in the eukaryotic translation initiation factor 2 alpha kinase 4 gene (EIF2AK4) are described in pulmonary veno-occlusive disease/pulmonary capillary hemangiomatosis. Here, we determine the frequency of these mutations and define the genotype-phenotype characteristics in a large cohort of patients diagnosed clinically with PAH. METHODS: Whole-genome sequencing was performed on DNA from patients with idiopathic and heritable PAH and with pulmonary veno-occlusive disease/pulmonary capillary hemangiomatosis recruited to the National Institute of Health Research BioResource-Rare Diseases study. Heterozygous variants in BMPR2 and biallelic EIF2AK4 variants with a minor allele frequency of <1:10 000 in control data sets and predicted to be deleterious (by combined annotation-dependent depletion, PolyPhen-2, and sorting intolerant from tolerant predictions) were identified as potentially causal. Phenotype data from the time of diagnosis were also captured. RESULTS: Eight hundred sixty-four patients with idiopathic or heritable PAH and 16 with pulmonary veno-occlusive disease/pulmonary capillary hemangiomatosis were recruited. Mutations in BMPR2 were identified in 130 patients (14.8%). Biallelic mutations in EIF2AK4 were identified in 5 patients with a clinical diagnosis of pulmonary veno-occlusive disease/pulmonary capillary hemangiomatosis. Furthermore, 9 patients with a clinical diagnosis of PAH carried biallelic EIF2AK4 mutations. These patients had a reduced transfer coefficient for carbon monoxide (Kco; 33% [interquartile range, 30%-35%] predicted) and younger age at diagnosis (29 years; interquartile range, 23-38 years) and more interlobular septal thickening and mediastinal lymphadenopathy on computed tomography of the chest compared with patients with PAH without EIF2AK4 mutations. However, radiological assessment alone could not accurately identify biallelic EIF2AK4 mutation carriers. Patients with PAH with biallelic EIF2AK4 mutations had a shorter survival. CONCLUSIONS: Biallelic EIF2AK4 mutations are found in patients classified clinically as having idiopathic and heritable PAH. These patients cannot be identified reliably by computed tomography, but a low Kco and a young age at diagnosis suggests the underlying molecular diagnosis. Genetic testing can identify these misclassified patients, allowing appropriate management and early referral for lung transplantation

Effect of Deutetrabenazine on Chorea Among Patients With Huntington Disease A Randomized Clinical Trial

Importance Deutetrabenazine is a novel molecule containing deuterium, which attenuates CYP2D6 metabolism and increases active metabolite half-lives and may therefore lead to stable systemic exposure while preserving key pharmacological activity. Objective To evaluate efficacy and safety of deutetrabenazine treatment to control chorea associated with Huntington disease. Design, Setting, and Participants Ninety ambulatory adults diagnosed with manifest Huntington disease and a baseline total maximal chorea score of 8 or higher (range, 0-28; lower score indicates less chorea) were enrolled from August 2013 to August 2014 and randomized to receive deutetrabenazine (n = 45) or placebo (n = 45) in a double-blind fashion at 34 Huntington Study Group sites. Interventions Deutetrabenazine or placebo was titrated to optimal dose level over 8 weeks and maintained for 4 weeks, followed by a 1-week washout. Main Outcomes and Measures Primary end point was the total maximal chorea score change from baseline (the average of values from the screening and day-0 visits) to maintenance therapy (the average of values from the week 9 and 12 visits) obtained by in-person visits. This study was designed to detect a 2.7-unit treatment difference in scores. The secondary end points, assessed hierarchically, were the proportion of patients who achieved treatment success on the Patient Global Impression of Change (PGIC) and on the Clinical Global Impression of Change (CGIC), the change in 36-Item Short Form– physical functioning subscale score (SF-36), and the change in the Berg Balance Test. Results Ninety patients with Huntington disease (mean age, 53.7 years; 40 women [44.4%]) were enrolled. In the deutetrabenazine group, the mean total maximal chorea scores improved from 12.1 (95% CI, 11.2-12.9) to 7.7 (95% CI, 6.5-8.9), whereas in the placebo group, scores improved from 13.2 (95% CI, 12.2-14.3) to 11.3 (95% CI, 10.0-12.5); the mean between-group difference was –2.5 units (95% CI, –3.7 to –1.3) (P < .001). Treatment success, as measured by the PGIC, occurred in 23 patients (51%) in the deutetrabenazine group vs 9 (20%) in the placebo group (P = .002). As measured by the CGIC, treatment success occurred in 19 patients (42%) in the deutetrabenazine group vs 6 (13%) in the placebo group (P = .002). In the deutetrabenazine group, the mean SF-36 physical functioning subscale scores decreased from 47.5 (95% CI, 44.3-50.8) to 47.4 (44.3-50.5), whereas in the placebo group, scores decreased from 43.2 (95% CI, 40.2-46.3) to 39.9 (95% CI, 36.2-43.6), for a treatment benefit of 4.3 (95% CI, 0.4 to 8.3) (P = .03). There was no difference between groups (mean difference of 1.0 unit; 95% CI, –0.3 to 2.3; P = .14), for improvement in the Berg Balance Test, which improved by 2.2 units (95% CI, 1.3-3.1) in the deutetrabenazine group and by 1.3 units (95% CI, 0.4-2.2) in the placebo group. Adverse event rates were similar for deutetrabenazine and placebo, including depression, anxiety, and akathisia. Conclusions and Relevance Among patients with chorea associated with Huntington disease, the use of deutetrabenazine compared with placebo resulted in improved motor signs at 12 weeks. Further research is needed to assess the clinical importance of the effect size and to determine longer-term efficacy and safety

Search for photonic signatures of gauge-mediated supersymmetry in 13 TeV pp collisions with the ATLAS detector

A search is presented for photonic signatures, motivated by generalized models of gauge-mediated supersymmetry breaking. This search makes use of proton-proton collision data at √s = 13 TeV corresponding to an integrated luminosity of 36.1 fb −1 recorded by the ATLAS detector at the LHC, and it explores models dominated by both strong and electroweak production of supersymmetric partner states. Experimental signatures incorporating an isolated photon and significant missing transverse momentum are explored. These signatures include events with an additional photon or additional jet activity not associated with any specific underlying quark flavor. No significant excess of events is observed above the Standard Model prediction, and 95% confidence-level upper limits of between 0.083 fb and 0.32 fb are set on the visible cross section of contributions from physics beyond the Standard Model. These results are interpreted in terms of lower limits on the masses of gluinos, squarks, and gauginos in the context of generalized models of gauge-mediated supersymmetry, which reach as high as 2.3 TeV for strongly produced and 1.3 TeV for weakly produced supersymmetric partner pairs

Study of J/ψ production and cold nuclear matter effects in pPb collisions at sNN \sqrt{{{s_{NN }}}} = 5 TeV

The production of J/psi mesons with rapidity 1.5 < y < 4.0 or 5.0 < y < 2.5 and transverse momentum PT < 14 GeV/e is studied with the LHCb detector in proton-lead collisions at a nucleon-nucleon centre-of-mass energy, root(NN)-N-S = 5 TeV. The J/psi mesons are reconstructed using the dimuon decay mode. The analysis is based on a data sample corresponding to an integrated luminosity of about 1.6 nb-1. For the first time the nuclear modification factor and forward-backward production ratio are determined separately for prompt J/psi mesons and J/psi from b-hadron decays. Clear suppression of prompt J/psi production with respect to proton-proton collisions at large rapidity is observed, while the production of J/psi from b-hadron decays is less suppressed. These results show good agreement with available theoretical predictions. The measurement shows that cold nuclear matter effects are important for interpretations of the related quark-gluon plasma signatures in heavy-ion collisions

A prospective, multi‐center study of the chocolate balloon in femoropopliteal peripheral artery disease: The Chocolate BAR registry

The Chocolate BAR study is a prospective multicenter post‐market registry designed to evaluate the safety and performance of the Chocolate percutaneous transluminal angioplasty balloon catheter in a broad population with symptomatic peripheral arterial disease. The primary endpoint is acute procedural success (defined as ≤30% residual stenosis without flow‐limiting dissection); secondary long‐term outcomes include freedom from target lesion revascularization (TLR), major unplanned amputation, survival, and patency. A total of 262 patients (290 femoropopliteal lesions) were enrolled at 30 US centers between 2012 and 2014. The primary endpoint of procedure success was achieved in 85.1% of cases, and freedom from stenting occurred in 93.1%. Bail out stenting by independent adjudication occurred in 1.6% of cases and there were no flow limiting dissections. There was mean improvement of 2.1 Rutherford classes (±1.5) at 12‐months, with 78.5% freedom from TLR, 97.2% freedom from major amputation, and 93.3% freedom from all‐cause mortality. Core Lab adjudicated patency was 64.1% at 12 months. Use of the Chocolate balloon in an “all‐comers” population achieved excellent procedural outcomes with low dissection rates and bailout stent use.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/143650/1/ccd27565_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/143650/2/ccd27565.pd