Alteplase is currently the only approved thrombolytic agent for treatment of acute ischaemic stroke, but interest is burgeoning in the development of new thrombolytic agents for systemic reperfusion ...with an improved safety profile, increased efficacy, and convenient delivery. Tenecteplase has emerged as a potential alternative thrombolytic agent that might be preferred over alteplase because of its ease of administration and reported efficacy in patients with large vessel occlusion. Ongoing research efforts are also looking at potential improvements in recanalisation with the use of adjunct therapies to intravenous thrombolysis. New treatment strategies are also emerging that aim to reduce the risk of vessel reocclusion after intravenous thrombolysis administration. Other research endeavors are looking at the use of intra-arterial thrombolysis after mechanical thrombectomy to induce tissue reperfusion. The growing implementation of mobile stroke units and advanced neuroimaging could boost the number of patients who can receive intravenous thrombolysis by shortening onset-to-treatment times and identifying patients with salvageable penumbra. Continued improvements in this area will be essential to facilitate the ongoing research endeavors and to improve delivery of new interventions.
An apparently single rotavirus A strain possessing a genotype constellation of G8-P8-I2-R2-C2-M2-A2-N2-T2-E2-H2 abruptly emerged, caused diarrhoea in children requiring hospitalisation, and increased ...to reach 27 % of strains detected during the first half of 2015 in Vietnam.
Since 2015, a series of endovascular trials transformed the management of patients with large vessel occlusion stroke. Most thrombectomy trials used restrictive eligibility criteria to optimize the ...chances of showing that thrombectomy could work. The problem arises when generalizing trial results into evidence-based recommendations. Many organizations, oblivious of this problem, translated verbatim restrictive trial eligibility criteria into authoritative guidelines, which limit the use of thrombectomy to highly selected patients. The clinical problem becomes as follows: what to do for all other stroke patients equally in need of care? The cycle of restrictive trial eligibility criteria, corresponding restrictive guidelines, observational studies of unvalidated practices showing other patients benefit, a new trial is needed, has been repeated often. Thrombectomy trials ought to have included all patients that could potentially benefit. If the signal that was looked for by restricting eligibility is at risk of being lost in the noise generated by the heterogeneity of patients, D. Sackett proposed a solution: to use the same criteria, not to select some patients and exclude others but to prespecify the subgroup of patients most likely to benefit. In this commentary, we propose a tiered approach, where the boundaries of treatment beneficiaries can be more rigorously tested and confirmed. Identification of these patients before the development of guidelines, which would have otherwise neglected these individuals, may open innumerable treatment opportunities to those who will instead be denied of them.
Basilar artery occlusion is one of the most devastating neurological conditions with high risks of disability and mortality. Despite the overwhelming benefit of endovascular therapy (EVT) in the ...anterior circulation and observational data supporting the efficacy of EVT in the posterior circulation, evidence from randomized controlled trials in basilar artery occlusion had been lacking until recently. The BEST (Basilar Artery Occlusion Endovascular Intervention Versus Standard Medical Treatment) and BASICS (Basilar Artery International Cooperation Study) randomized trials showed a nonsignificant direction of benefit but failed to demonstrate the superiority of EVT over standard medical therapy in basilar artery occlusion. However, these trials paved the way for 2 subsequent positive trials by highlighting the importance of consecutive recruitment, fast enrollment and avoidance or minimization of cross-over. The recently completed ATTENTION (Endovascular Treatment for Acute Basilar Artery Occlusion) and BAOCHE (Basilar Artery Occlusion Chinese Endovascular Trial) trials showed that EVT is beneficial for basilar artery occlusion within 24 hours of onset, with a treatment effect similar to what has been shown in anterior circulation large vessel occlusion ischemic stroke. In this topical review, we examine and contextualize the current evidence on EVT for basilar artery occlusion.
Nature of partial sigma bond Nguyen, Lam H.; Truong, Thanh N.
Journal of computational chemistry,
October 5, 2024), Letnik:
45, Številka:
26
Journal Article
Recenzirano
This study investigates the formation of partial sigma (σ) covalent bonds in experimentally synthesizable biradicals formed from hydrogenated and fluorinated C8, C20, and C60 cage structures, by ...assessing their stability, geometry, and bonding character in singlet and triplet states using restricted B3LYP‐D3/6–31+G(d,p) theory, natural bond orbital (NBO) analysis, and complete active space self‐consistent field (CASSCF) method. The results show that these partial σCC bonds have Wiberg bond orders of 0.38 to 0.48 and bond lengths ranging from 2.62 Å to 5.93 Å. Cage size influences the characteristics of the highest occupied molecular orbital (HOMO) and the lowest unoccupied molecular orbital (LUMO), with electrons favoring more antibonding orbitals in smaller cages where electrons reside more on the exterior of the cage and favoring bonding orbitals in larger ones where electrons are more in the interior. Fluorination enhances electron density on bonding orbitals. The analysis further clarified that the differentiation between antibonding and bonding features of HOMOs and LUMOs extends beyond merely electron transfer from s‐ to p‐atomic orbitals, also noting possible interactions of the same symmetry repel. The study also introduces hyperconjugation from α‐position CH bonds as a factor in stabilizing partial σ‐bond formation. The results also caution against the use of broken symmetry methodology in unrestricted SCF wavefunctions for biradicals, such as those in this study as it may cause large spin contamination and thus errors in the calculated electronic properties results.
Nature of partial sigma bond (PSB).
Basilar artery occlusion (BAO) is an uncommon event, and leads to poor outcome in an estimated 60 to 80% of patients. Two early randomized trials, BASICS and BEST demonstrated equivocal benefit of ...endovascular therapy (EVT) compared to medical management. These trials helped in forming the design, sample size and eligibility criteria for the subsequent two trials, ATTENTION and BAOCHE which demonstrated superiority of EVT over medical management. In this commentary, we look at the evolution of how early BAO studies formed the building blocks for successive BAO trials, review lessons learned, and opportunities for future research.
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