Explore the vast range of titles available.

The threefold aim of this experimental study was to test the correlation of cardiac troponin I released to myocardial infarction size and myocardial fixation of anticardiac troponin I antibody and to determine how long after myocardial infarction the measure of cardiac troponin I concentration can evaluate myocardial infarction size. Forty rabbits were assigned either to a control group or to an experimental preconditioned group. Infarction was obtained by tightening a snare around the left anterior descending artery. Serial venous blood samples were drawn for measurement of cardiac troponin I. The rabbits were sacrificed at 72 hours and a histological study was performed to determine the infarct size and the size of the area void of fixation of anticardiac troponin I antibody. There was a linear correlation between the total amount of CTn I released and both infarct size (r=0.45, p<0.02) and the size of the area void of anti-cardiac troponin I antibody (r=0.47, p<0.02). These two sizes were strongly correlated (r=0.95, p<0.02). The hour 9 CTn I sample was the best correlated with both the infarct size (r=0.47, p<0.02) and the size of area void of anticardiac troponin I antibody (r=0.45, p<0.02). Our study shows that: 1) cardiac troponin I release is correlated to both myocardial infarction size and the size of area void of fixation of anticardiac troponin I antibody, 2) the area void of anticardiac troponin I antibody fixation includes the whole ischemic area, and 3) evaluation of myocardial infarction size can be obtained by CTn I concentration as early as the ninth hour.

OBJECTIVE: Medication administration errors (MAEs) are the second most frequent type of medication errors, as has been shown in different studies in the literature. The aims of this observational study were to assess the rate and the potential clinical significance of MAEs and to determine the associated risk factors. DESIGN: In two departments, Geriatric Unit (GU) and Cardiovascular-Thoracic Surgery Unit (CTSU) of Besançon University Hospital (France), MAEs were identified using the undisguised observation technique and classified according to the definitions of the American Society of Health-System Pharmacists. Injectable administration, lack of nurses's standardized protocol for the preparation and administration of drugs, incomplete or illegible prescription and nurse's workload were analysed as potential risk factors of MAEs in multivariate logistic regression analysis. RESULTS: During a period of 20 days, opportunities for error concerning 56 patients and 78 MAEs (58 in CTSU and 26 in GU) were observed. The medication administration error rate was 14.9%. Dose errors were the most frequent (41%) errors, followed by wrong time (26%) and wrong rate errors (1996). No potential fatal errors were observed, 8 (10%) were estimated as potentially life-threatening, 20 (26%) potentially significant and 50 (64%) potentially minor. Nurse workload and incomplete or illegible prescriptions were two independent risk factors of MAEs. CONCLUSION: According to these data, the quality of the medication administration process needs to be optimized in hospitals in order to minimize the incidence of iatrogenic preventable diseases.

Evidence regarding whether imaging can be used effectively to select patients for endovascular thrombectomy (EVT) is scarce. We aimed to investigate the association between baseline imaging features and safety and efficacy of EVT in acute ischaemic stroke caused by anterior large-vessel occlusion. In this meta-analysis of individual patient-level data, the HERMES collaboration identified in PubMed seven randomised trials in endovascular stroke that compared EVT with standard medical therapy, published between Jan 1, 2010, and Oct 31, 2017. Only trials that required vessel imaging to identify patients with proximal anterior circulation ischaemic stroke and that used predominantly stent retrievers or second-generation neurothrombectomy devices in the EVT group were included. Risk of bias was assessed with the Cochrane handbook methodology. Central investigators, masked to clinical information other than stroke side, categorised baseline imaging features of ischaemic change with the Alberta Stroke Program Early CT Score (ASPECTS) or according to involvement of more than 33% of middle cerebral artery territory, and by thrombus volume, hyperdensity, and collateral status. The primary endpoint was neurological functional disability scored on the modified Rankin Scale (mRS) score at 90 days after randomisation. Safety outcomes included symptomatic intracranial haemorrhage, parenchymal haematoma type 2 within 5 days of randomisation, and mortality within 90 days. For the primary analysis, we used mixed-methods ordinal logistic regression adjusted for age, sex, National Institutes of Health Stroke Scale score at admission, intravenous alteplase, and time from onset to randomisation, and we used interaction terms to test whether imaging categorisation at baseline modifies the association between treatment and outcome. This meta-analysis was prospectively designed by the HERMES executive committee but has not been registered. Among 1764 pooled patients, 871 were allocated to the EVT group and 893 to the control group. Risk of bias was low except in the THRACE study, which used unblinded assessment of outcomes 90 days after randomisation and MRI predominantly as the primary baseline imaging tool. The overall treatment effect favoured EVT (adjusted common odds ratio [cOR] for a shift towards better outcome on the mRS 2·00, 95% CI 1·69–2·38; p<0·0001). EVT achieved better outcomes at 90 days than standard medical therapy alone across a broad range of baseline imaging categories. Mortality at 90 days (14·7% vs 17·3%, p=0·15), symptomatic intracranial haemorrhage (3·8% vs 3·5%, p=0·90), and parenchymal haematoma type 2 (5·6% vs 4·8%, p=0·52) did not differ between the EVT and control groups. No treatment effect modification by baseline imaging features was noted for mortality at 90 days and parenchymal haematoma type 2. Among patients with ASPECTS 0–4, symptomatic intracranial haemorrhage was seen in ten (19%) of 52 patients in the EVT group versus three (5%) of 66 patients in the control group (adjusted cOR 3·94, 95% CI 0·94–16·49; pinteraction=0·025), and among patients with more than 33% involvement of middle cerebral artery territory, symptomatic intracranial haemorrhage was observed in 15 (14%) of 108 patients in the EVT group versus four (4%) of 113 patients in the control group (4·17, 1·30–13·44, pinteraction=0·012). EVT achieves better outcomes at 90 days than standard medical therapy across a broad range of baseline imaging categories, including infarcts affecting more than 33% of middle cerebral artery territory or ASPECTS less than 6, although in these patients the risk of symptomatic intracranial haemorrhage was higher in the EVT group than the control group. This analysis provides preliminary evidence for potential use of EVT in patients with large infarcts at baseline. Medtronic.

Central retinal artery occlusion (CRAO) is a subtype of ischaemic stroke that results in acute monocular vision loss. Although open-label studies and meta-analyses have suggested that early intravenous thrombolysis might improve visual acuity, no randomised controlled trials have yet confirmed this benefit. We aimed to compare the safety and efficacy of intravenous alteplase with oral aspirin in patients with CRAO treated within 4·5 h of onset of severe vision loss. THEIA was a multicentre, double-dummy, patient-blinded, assessor-blinded, randomised, controlled, phase 3 trial conducted across 16 hospitals with stroke units in France. Adults (aged ≥18 years) presenting with sudden, severe, and persistent monocular vision loss (Snellen <20/400) due to suspected non-arteritic acute CRAO were eligible for inclusion. Participants were randomly assigned (1:1), stratified by centre, to receive either 0·9 mg/kg of bodyweight intravenous alteplase and oral placebo (alteplase group) or 300 mg oral aspirin and intravenous saline placebo (aspirin group) within 4·5 h of symptom onset. Patients, outcome assessors, and the study sponsor were masked to treatment allocation; treating nurses and neurologists were unmasked. The primary efficacy outcome was improvement in visual acuity of at least 0·3 logarithm of the minimum angle of resolution (LogMAR) from baseline to 1 month, analysed in the full analysis set, which included all patients who received the complete intervention and a visual acuity assessment at baseline. Safety outcomes included serious adverse events, particularly intracranial and extracranial bleeding, analysed in all randomly assigned participants. This study is registered at ClinicalTrials.gov (NCT03197194) and is completed. Between June 8, 2018, and Oct 2, 2023, 70 patients (mean age 70 years [SD 9]; 25 [36%] women and 45 [64%] men) were enrolled and randomly assigned to either the alteplase group (35 [50%]) or the aspirin group (35 [50%]). In total, 65 (93%) patients received the allocated treatment: 34 (97%) in the alteplase group and 31 (89%) in the aspirin group. Mean time from symptom onset to treatment initiation was 232·4 min (SD 43·6). Among 56 patients with available data on the primary endpoint, 19 (66%) of 29 patients in the alteplase group and 13 (48%) of 27 patients in the aspirin group showed an improvement in visual acuity of at least 0·3 LogMAR at 1 month (unadjusted risk difference 17·4 [95% CI –11·8 to 46·5]; adjusted odds ratio 1·1 [95% CI 0·07 to 18·39]; p=0·95). One asymptomatic intracranial haemorrhage related to study treatment was reported in the alteplase group. 14 serious adverse events unrelated to treatment occurred in 11 patients overall (six [17%] in the aspirin group and five [14%] in the alteplase group). No symptomatic haemorrhages or major bleeding related to study treatment were reported. Intravenous alteplase administered within 4·5 h of CRAO onset was not associated with a significant improvement in visual acuity compared with aspirin, despite a higher rate of improvement in the alteplase group. However, the study was likely underpowered to detect a statistical difference. Although no safety concerns related to alteplase were identified, the overall modest recovery rates underscore the need for individual patient-level data meta-analyses with forthcoming randomised controlled trials to clarify the potential benefit of thrombolysis or aspirin in patients with acute CRAO. French Ministry of Health and Boehringer Ingelheim, France.

The removal of organic contaminants from water by adsorption processes results in spent adsorbents, and, in this research, the use of homogeneous advanced oxidation processes for destructive regeneration of adsorbents is investigated. These two homogeneous advanced oxidation processes are examined: hydrogen peroxide/ozone and ultraviolet light/hydrogen peroxide. The impacts of adsorbent, adsorbate, and temperature on regeneration were examined. The process was evaluated by the destruction efficiency, rate of regeneration, and the quantity of oxidants consumed. This study demonstrates that the regeneration of adsorbents by homogeneous advanced oxidation is not practical. This paper does not suggest other advanced oxidation processes that employ Fentons reagant or heterogeneous reactions using photoreactive metal catalysts (that is,${\\rm TiO}_{2}$) are ineffective for regeneration of adsorbents. The regeneration rate was found to be much faster for smaller particle size adsorbents and weakly adsorbed compounds; in some cases, nearly 100% of the virgin capacity was recovered after regeneration. However, in all cases, the regeneration process consumes more oxidants than would be required by simply using a conventional advanced oxidation process for destroying organic contaminants. The high consumption of oxidants may be due to the slow rate of organic desorption and redox reactions with the adsorbent surface. Accordingly, regeneration processes using homogeneous advanced oxidation is not practical unless an adsorbent is developed that exhibits fast desorption kinetics and the surface does not react with the oxidants.

Cerebrovascular disorders in association with licit or illicit drugs have rarely been reported. We report a first case of stroke associated with the parenteral use of ephedrine. A 44-year-old woman underwent spinal anaesthesia for varicose vein surgery. She was usually treated with propranolol and occasionally with phenoxazoline. During anaesthesia, ephedrine was administered by the venous route because of arterial hypotension. She developed intracranial hypertension and focal cerebral deficits related to multiple haemorrhagic cerebral infarcts associated with a reversible beading appearance on angiography consistent with the diagnosis of acute cerebral arteritis. The role of ephedrine in this case is discussed beside other causes of acute cerebral arteritis.

Cerebrovascular disorders in association with licit or illicit drugs have rarely been reported. We report a first case of stroke associated with the parenteral use of ephedrine. A 44-year-old woman underwent spinal anaesthesia for varicose vein surgery. She was usually treated with propranolol and occasionally with phenoxazoline. During anaesthesia, ephedrine was administered by the venous route because of arterial hypotension. She developed intracranial hypertension and focal cerebral deficits related to multiple haemorrhagic cerebral infarcts associated with a reversible beading appearance on angiography consistent with the diagnosis of acute cerebral arteritis. The role of ephedrine in this case is discussed beside other causes of acute cerebral arteritis.