Background and Purpose - Most acute ischemic stroke patients arrive after the 3- hour time window for recombinant tissue plasminogen activator (rtPA) administration. The Desmoteplase In Acute Ischemic Stroke trial (DI...Background and Purpose - Most acute ischemic stroke patients arrive after the 3- hour time window for recombinant tissue plasminogen activator (rtPA) administration. The Desmoteplase In Acute Ischemic Stroke trial (DIAS) was a dose- finding randomized trial designed to evaluate the safety and efficacy of intravenous desmoteplase, a highly fibrin- specific and nonneurotoxic thrombolytic agent, administered within 3 to 9 hours of ischemic stroke onset in patients with perfusion/diffusion mismatch on MRI. Methods - DIAS was a placebo- controlled, double- blind, randomized, dose- finding phase II trial. Patients with National Institute of Health Stroke Scale (NIHSS) scores of 4 to 20 and MRI evidence of perfusion/diffusion mismatch were eligible. Of 104 patients, the first 47 (referred to as Part 1) were randomized to fixed doses of desmoteplase (25 mg, 37.5 mg, or 50 mg) or placebo. Because of an excessive rate of symptomatic intracranial hemorrhage (sICH), lower weight- adjusted doses escalating through 62.5 μ g/kg, 90 μ g/kg, and 125 μ g/kg were subsequently investigated in 57 patients (referred to as Part 2). The safety endpoint was the rate of sICH. Efficacy endpoints were the rate of reperfusion on MRI after 4 to 8 hours and clinical outcome as assessed by NIHSS, modified Rankin scale, and Barthel Index at 90 days. Results - Part 1 was terminated prematurely because of high rates of sICH with desmoteplase (26.7% ). In Part 2, the sICH rate was 2.2% . No sICH occurred with placebo in either part. Reperfusion rates up to 71.4% (P=0.0012) were observed with desmoteplase (125 μ g/kg) compared with 19.2% with placebo. Favorable 90- day clinical outcome was found in 22.2% of placebo- treated patients and between 13.3% (62.5 μ g/kg; P=0.757) and 60.0% (125 μ g/kg; P=0.0090) of desmote- plase- treated patients. Early reperfusion correlated favorably with clinical outcome (P=0.0028). Favorable outcome occurred in 52.5% of patients experiencing reperfusion versus 24.6% of patients without reperfusion. Conclusions - Intravenous desmoteplase administered 3 to 9 hours after acute ischemic stroke in patients selected with perfusion/diffusion mismatch is associated with a higher rate of reperfusion and better clinical outcome compared with placebo. The sICH rate with desmoteplase was low, using doses up to 125 μ g/kg.展开更多
Population growth has consequences for intense use of aquatic ecosystems. Samples were taken, between 2013 and 2014, in the reservoirs ＂Algodoeiro＂ and ＂Gloria＂ in Sergipe, Brazil. TSI （Trophic State Index） and ...Population growth has consequences for intense use of aquatic ecosystems. Samples were taken, between 2013 and 2014, in the reservoirs ＂Algodoeiro＂ and ＂Gloria＂ in Sergipe, Brazil. TSI （Trophic State Index） and WQI （Water Quality Index） were used. It was determined the parameters such as conductivity, dissolved oxygen, total nitrogen, total phosphorus and chlorophyll. TSI has been applied, in ＂Algodoeiro＂, which was classified as mesotrophic. With the increase of rainfall in 2014, this reservoir changed its condition to eutrophic. ＂Gloria＂ reservoir was already classified in super-eutrophication. Regarding the WQI, the reservoirs were classified in Class IV, indicating a critically degraded condition.展开更多
目的分析神经梅毒(neurosyphilis,NS)患者的临床资料,探讨影响其日常生活活动能力(activity of daily living,ADL)的因素。方法对90例NS患者的临床资料进行回顾性分析,使用巴塞尔指数(Barthel index,BI)评估患者入院时ADL,将患者分为无...目的分析神经梅毒(neurosyphilis,NS)患者的临床资料,探讨影响其日常生活活动能力(activity of daily living,ADL)的因素。方法对90例NS患者的临床资料进行回顾性分析,使用巴塞尔指数(Barthel index,BI)评估患者入院时ADL,将患者分为无需依赖组、轻度依赖组和中重度依赖组,通过比较分析和多因素线性回归分析,探讨ADL的影响因素。采用受试者操作特征(receiver operating characteristic,ROC)曲线评估临床指标对出院时ADL恢复不良(BI评分≤60分)患者的预测效能。结果90例NS患者,年龄(54.17±12.45)岁,男性70例(77.78%)。临床表现中精神行为异常(44.44%)最为常见,其次为肢体感觉或运动障碍(25.56%)、构音障碍(16.67%)。根据BI评分分组,无需依赖组41例(45.6%),轻度依赖组31例(34.4%),中重度依赖组18例(20.0%)。3组比较,中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)逐渐增高[2.80(1.97,4.73)vs.3.80(2.28,4.89)vs.5.37(3.76,7.20)],中重度依赖组分别高于无需依赖组及轻度依赖组(P<0.05);脑脊液蛋白浓度逐渐增多[427(341,644)mg/L vs.553(425,830)mg/L vs.933(641,1706.5)mg/L],两两比较均有统计学差异(P<0.05)。多因素线性回归分析显示,NLR(β=-0.242,P=0.018)和脑脊液蛋白浓度(β=-0.461,P<0.001)与入院时的ADL呈负相关。脑脊液蛋白浓度预测出院时ADL恢复不良患者的曲线下面积(area under the curve,AUC)为0.806(95%CI:0.708~0.883,P<0.001),最佳截断值为620 mg/L,敏感性和特异性分别为86.7%和69.4%。结论NS患者主要临床表现为精神行为异常,NLR、脑脊液蛋白浓度增高与ADL降低相关联,早期积极干预炎症反应及脑脊液蛋白异常可能为改善患者预后提供新思路。展开更多
文摘Background and Purpose - Most acute ischemic stroke patients arrive after the 3- hour time window for recombinant tissue plasminogen activator (rtPA) administration. The Desmoteplase In Acute Ischemic Stroke trial (DIAS) was a dose- finding randomized trial designed to evaluate the safety and efficacy of intravenous desmoteplase, a highly fibrin- specific and nonneurotoxic thrombolytic agent, administered within 3 to 9 hours of ischemic stroke onset in patients with perfusion/diffusion mismatch on MRI. Methods - DIAS was a placebo- controlled, double- blind, randomized, dose- finding phase II trial. Patients with National Institute of Health Stroke Scale (NIHSS) scores of 4 to 20 and MRI evidence of perfusion/diffusion mismatch were eligible. Of 104 patients, the first 47 (referred to as Part 1) were randomized to fixed doses of desmoteplase (25 mg, 37.5 mg, or 50 mg) or placebo. Because of an excessive rate of symptomatic intracranial hemorrhage (sICH), lower weight- adjusted doses escalating through 62.5 μ g/kg, 90 μ g/kg, and 125 μ g/kg were subsequently investigated in 57 patients (referred to as Part 2). The safety endpoint was the rate of sICH. Efficacy endpoints were the rate of reperfusion on MRI after 4 to 8 hours and clinical outcome as assessed by NIHSS, modified Rankin scale, and Barthel Index at 90 days. Results - Part 1 was terminated prematurely because of high rates of sICH with desmoteplase (26.7% ). In Part 2, the sICH rate was 2.2% . No sICH occurred with placebo in either part. Reperfusion rates up to 71.4% (P=0.0012) were observed with desmoteplase (125 μ g/kg) compared with 19.2% with placebo. Favorable 90- day clinical outcome was found in 22.2% of placebo- treated patients and between 13.3% (62.5 μ g/kg; P=0.757) and 60.0% (125 μ g/kg; P=0.0090) of desmote- plase- treated patients. Early reperfusion correlated favorably with clinical outcome (P=0.0028). Favorable outcome occurred in 52.5% of patients experiencing reperfusion versus 24.6% of patients without reperfusion. Conclusions - Intravenous desmoteplase administered 3 to 9 hours after acute ischemic stroke in patients selected with perfusion/diffusion mismatch is associated with a higher rate of reperfusion and better clinical outcome compared with placebo. The sICH rate with desmoteplase was low, using doses up to 125 μ g/kg.
文摘Population growth has consequences for intense use of aquatic ecosystems. Samples were taken, between 2013 and 2014, in the reservoirs ＂Algodoeiro＂ and ＂Gloria＂ in Sergipe, Brazil. TSI （Trophic State Index） and WQI （Water Quality Index） were used. It was determined the parameters such as conductivity, dissolved oxygen, total nitrogen, total phosphorus and chlorophyll. TSI has been applied, in ＂Algodoeiro＂, which was classified as mesotrophic. With the increase of rainfall in 2014, this reservoir changed its condition to eutrophic. ＂Gloria＂ reservoir was already classified in super-eutrophication. Regarding the WQI, the reservoirs were classified in Class IV, indicating a critically degraded condition.
文摘目的分析神经梅毒(neurosyphilis,NS)患者的临床资料,探讨影响其日常生活活动能力(activity of daily living,ADL)的因素。方法对90例NS患者的临床资料进行回顾性分析,使用巴塞尔指数(Barthel index,BI)评估患者入院时ADL,将患者分为无需依赖组、轻度依赖组和中重度依赖组,通过比较分析和多因素线性回归分析,探讨ADL的影响因素。采用受试者操作特征(receiver operating characteristic,ROC)曲线评估临床指标对出院时ADL恢复不良(BI评分≤60分)患者的预测效能。结果90例NS患者,年龄(54.17±12.45)岁,男性70例(77.78%)。临床表现中精神行为异常(44.44%)最为常见,其次为肢体感觉或运动障碍(25.56%)、构音障碍(16.67%)。根据BI评分分组,无需依赖组41例(45.6%),轻度依赖组31例(34.4%),中重度依赖组18例(20.0%)。3组比较,中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)逐渐增高[2.80(1.97,4.73)vs.3.80(2.28,4.89)vs.5.37(3.76,7.20)],中重度依赖组分别高于无需依赖组及轻度依赖组(P<0.05);脑脊液蛋白浓度逐渐增多[427(341,644)mg/L vs.553(425,830)mg/L vs.933(641,1706.5)mg/L],两两比较均有统计学差异(P<0.05)。多因素线性回归分析显示,NLR(β=-0.242,P=0.018)和脑脊液蛋白浓度(β=-0.461,P<0.001)与入院时的ADL呈负相关。脑脊液蛋白浓度预测出院时ADL恢复不良患者的曲线下面积(area under the curve,AUC)为0.806(95%CI:0.708~0.883,P<0.001),最佳截断值为620 mg/L,敏感性和特异性分别为86.7%和69.4%。结论NS患者主要临床表现为精神行为异常,NLR、脑脊液蛋白浓度增高与ADL降低相关联,早期积极干预炎症反应及脑脊液蛋白异常可能为改善患者预后提供新思路。
