In the spring of 2021, reports of rare and unusual venous thrombosis in association with the ChAdOx1 and Ad26.COV2.S adenovirus-based coronavirus vaccines led to a brief suspension of their use by ...several countries. Thromboses in the cerebral and splanchnic veins among patients vaccinated in the preceding 4 weeks were described in 17 patients out of 7.98 million recipients of the Ad26.COV2.S vaccine (with 3 fatalities related to cerebral vein thrombosis) and 169 cases of cerebral vein thrombosis among 35 million ChAdOx1 recipients. Events were associated with thrombocytopenia and anti-PF4 (antibodies directed against platelet factor 4), leading to the designation vaccine-induced immune thrombotic thrombocytopenia. Unlike the related heparin-induced thrombotic thrombocytopenia, with an estimated incidence of <1:1000 patients treated with heparin, and a mortality rate of 25%, vaccine-induced immune thrombotic thrombocytopenia has been reported in 1:150 000 ChAdOx1 recipients and 1:470 000 Ad26.COV.2 recipients, with a reported mortality rate of 20% to 30%. Early recognition of this complication should prompt testing for anti-PF4 antibodies and acute treatment targeting the autoimmune and prothrombotic processes. Intravenous immunoglobulin (1 g/kg for 2 days), consideration of plasma exchange, and nonheparin anticoagulation (argatroban, fondaparinux) are recommended. In cases of cerebral vein thrombosis, one should monitor for and treat the known complications of venous congestion as they would in patients without vaccine-induced immune thrombotic thrombocytopenia. Now that the Ad26.COV2.S has been reapproved for use in several countries, it remains a critical component of our pharmacological armamentarium in stopping the spread of the human coronavirus and should be strongly recommended to patients. At this time, the patient and community-level benefits of these two adenoviral vaccines vastly outweigh the rare but serious risks of vaccination. Due to the relatively low risk of severe coronavirus disease 2019 (COVID-19) in young women (<50 years), it is reasonable to recommend an alternative vaccine if one is available. Ongoing postmarketing observational studies are important for tracking new vaccine-induced immune thrombotic thrombocytopenia cases and other rare side effects of these emergent interventions.
In this study, we estimate rice residue, associated burning emissions, and compare results with existing emissions inventories employing a bottom-up approach. We first estimated field-level ...post-harvest rice residues, including separate fuel-loading factors for rice straw and rice stubble. Results suggested fuel-loading factors of 0.27 kg m−2 (±0.033), 0.61 kg m−2 (±0.076), and 0.88 kg m−2 (±0.083) for rice straw, stubble, and total post-harvest biomass, respectively. Using these factors, we quantified potential emissions from rice residue burning and compared our estimates with other studies. Our results suggest total rice residue burning emissions as 2.24 Gg PM2.5, 36.54 Gg CO and 567.79 Gg CO2 for Hanoi Province, which are significantly higher than earlier studies. We attribute our higher emission estimates to improved fuel-loading factors; moreover, we infer that some earlier studies relying on residue-to-product ratios could be underestimating rice residue emissions by more than a factor of 2.3 for Hanoi, Vietnam. Using the rice planted area data from the Vietnamese government, and combining our fuel-loading factors, we also estimated rice residue PM2.5 emissions for the entirety of Vietnam and compared these estimates with an existing all-sources emissions inventory, and the Global Fire Emissions Database (GFED). Results suggest 75.98 Gg of PM2.5 released from rice residue burning accounting for 12.8% of total emissions for Vietnam. The GFED database suggests 42.56 Gg PM2.5 from biomass burning with 5.62 Gg attributed to agricultural waste burning indicating satellite-based methods may be significantly underestimating emissions. Our results not only provide improved residue and emission estimates, but also highlight the need for emissions mitigation from rice residue burning.
Objective
We conducted a post hoc exploratory analysis of Remote Ischemic Conditioning for Acute Moderate Ischemic Stroke (RICAMIS) to determine whether early remote ischemic conditioning (RIC) ...initiation after stroke onset was associated with clinical outcome in patients with acute moderate ischemic stroke.
Methods
In RICAMIS, patients receiving RIC treatment in the intention‐to‐treat analysis were divided into 2 groups based on onset‐to‐treatment time (OTT): early RIC group (OTT ≤ 24 hours) and late RIC group (OTT 24–48 hours). Patients receiving usual care without RIC treatment from intention‐to‐treat analysis were assigned as the control group. The primary outcome was excellent functional outcome at 90 days.
Results
Among 1,776 patients from intention‐to‐treat analysis, 387 were in the early RIC group, 476 in the late RIC group, and 913 in the control group. In the post hoc exploratory analysis, a higher proportion of excellent functional outcome was found in the early RIC versus control group (adjusted absolute difference = 8.1%, 95% confidence interval CI = 2.5%–13.8%, p = 0.005), but no difference in outcomes was detected in the late RIC versus control group (adjusted absolute difference = 3.3%, 95% CI = −2.1% to 8.6%, p = 0.23), or in the early RIC versus late RIC group (adjusted absolute difference = 5.0%, 95% CI = −1.3% to 11.2%, p = 0.12). Similar results were found in the per‐protocol analysis.
Interpretation
Among patients with acute moderate ischemic stroke who are not candidates for intravenous thrombolysis or endovascular therapy, early RIC initiation within 24 hours of onset may be associated with higher likelihood of excellent clinical outcome. ANN NEUROL 2023;94:561–571
According to statistics of the American Cancer Society, in 2015, there are about 91,270 American adults diagnosed with melanoma of the skin. For the European Union, there are over 90,000 new cases of ...melanoma annually. Although melanoma only accounts for about 1% of all skin cancers, it causes most of the skin cancer deaths. Melanoma is considered one of the fastest-growing forms of skin cancer, and hence the early detection is crucial, as early detection is helpful and can provide strong recommendations for specific and suitable treatment regimens. In this work, we propose a method to detect melanoma skin cancer with automatic image processing techniques. Our method includes three stages: pre-process images of skin lesions by adaptive principal curvature, segment skin lesions by the colour normalisation and extract features by the ABCD rule. We provide experimental results of the proposed method on the publicly available International Skin Imaging Collaboration (ISIC) skin lesions dataset. The acquired results on melanoma skin cancer detection indicates that the proposed method has high accuracy, and overall, a good performance: for the segmentation stage, the accuracy, Dice, Jaccard scores are 96.6%, 93.9% and 88.7%, respectively; and for the melanoma detection stage, the accuracy is up to 100% for a selected subset of the ISIC dataset.
Basilar artery occlusion is a rare and severe condition. The effectiveness of endovascular thrombectomy in patients with basilar artery occlusion was unclear until recently, because these patients ...were excluded from most trials of endovascular thrombectomy for large-vessel occlusion ischaemic stroke.
The Basilar Artery International Cooperation Study (BASICS) and the Basilar Artery Occlusion Endovascular Intervention versus Standard Medical Treatment (BEST) trials, specifically designed to investigate the benefit of thrombectomy in patients with basilar artery occlusion, did not find significant evidence of a benefit of endovascular thrombectomy in terms of disability outcomes at 3 months after stroke. However, these trials suggested a potential benefit of endovascular thrombectomy in patients presenting with moderate-to-severe symptoms. Subsequently, the Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) and the Basilar Artery Occlusion Chinese Endovascular (BAOCHE) trials, which compared endovascular thrombectomy versus medical therapy within 24 h of onset, showed clear benefit of endovascular thrombectomy in reducing disability and mortality, particularly in patients with moderate-to-severe symptoms. The risk of intracranial haemorrhage with endovascular thrombectomy was similar to the risk in anterior circulation stroke. Thrombectomy was beneficial regardless of age, baseline characteristics, the presence of intracranial atherosclerotic disease, and time from symptom onset to randomisation. Therefore, the question of whether endovascular thrombectomy is beneficial in basilar artery occlusion now appears to be settled in patients with moderate-to-severe symptoms, and endovascular thrombectomy should be offered to eligible patients.
Key outstanding issues are the potential benefits of endovascular thrombectomy in patients with mild symptoms, the use of intravenous thrombolysis in an extended time window (ie, after 4·5 h of symptom onset), and the optimal endovascular technique for thrombectomy. Dedicated training programmes and automated software to assist with the assessment of imaging prognostic markers could be useful in the selection of patients who might benefit from endovascular thrombectomy. Large international research networks should be built to address knowledge gaps in this field and allow the conduct of clinical trials with fast and consecutive enrolment and a diverse ethnic representation.
Six undescribed prenylated chalcones gagones A–F were isolated from the acetone fraction of Mansonia gagei heartwood. Their structures were unambiguously established based on spectroscopic analysis ...(HRESIMS, 1D and 2D NMR), as well as comparison to literature data. Their absolute configurations were elucidated using DP4 and electronic circular dichroism calculations. Isolated compounds were evaluated for their inhibitory activity against α-glucosidase and DPPH assay. All of the tested compounds exhibited better activity than that of acarbose (IC50 93.6 ± 0.5 μM). Among them, gagone D exhibited the highest α-glucosidase inhibitory with the IC50 value of 3.6 ± 0.4 μM. For antioxidant activity, gagones A–C, and E showed more active than that of ascorbic acid (IC50 30.2 ± 0.5 μM) with the IC50 values of 13.2 ± 0.7, 20.1 ± 0.4, 19.3 ± 0.5 and 12.8 ± 0.2 μM, respectively.
Six undescribed prenylated chalcones have been isolated from the acetone fraction of Mansonia gagei heartwood. Some isolated chalcones significantly exhibited α-glucosidase inhibitory activity and antioxidant activity. Display omitted
•Six undescribed chalcones were isolated from the acetone fraction of Mansonia gagei heartwood.•The stereochemistry was determined by using DP4 protocol and ECD calculations.•Their antioxidant and α-glucosidase activities were evaluated.
The efficacy of thrombolysis (IVT) in minor stroke (National Institutes of Health Stroke Scale score, 0-5) remains inconclusive. The aim of this study is to compare the effectiveness and safety of ...IVT with best medical therapy (BMT) by means of a systematic review and meta-analysis of randomized controlled trials and observational studies.
We searched the PubMed, Embase, Cochrane Library, and Web of Science databases to obtain articles related to IVT in minor stroke from inception until August 10, 2023. The primary outcome was an excellent functional outcome, defined as a modified Rankin Scale score of 0 or 1 at 90 days. The associations were calculated for the overall and preformulated subgroups by using the odds ratios (ORs). This study was registered with PROSPERO (CRD42023445856).
A total of 20 high-quality studies, comprised of 13 397 patients with acute minor ischemic stroke, were included. There were no significant differences observed in the modified Rankin Scale scores of 0 to 1 (OR, 1.10 95% CI, 0.89-1.37) and 0 to 2 (OR, 1.16 95% CI, 0.95-1.43), mortality rates (OR, 0.67 95% CI, 0.39-1.15), recurrent stroke (OR, 0.89 95% CI, 0.57-1.38), and recurrent ischemic stroke (OR, 1.09 95% CI, 0.68-1.73) between the IVT and BMT group. There were differences between the IVT group and the BMT group in terms of early neurological deterioration (OR, 1.81 95% CI, 1.17-2.80), symptomatic intracranial hemorrhage (OR, 7.48 95% CI, 3.55-15.76), and hemorrhagic transformation (OR, 4.73 95% CI, 2.40-9.34). Comparison of modified Rankin Scale score of 0 to 1 remained unchanged in subgroup patients with nondisabling deficits or compared with those using antiplatelets.
These findings indicate that IVT does not yield significant improvement in the functional prognosis of patients with acute minor ischemic stroke. Additionally, it is associated with an increased risk of symptomatic intracranial hemorrhage when compared with the BMT. Moreover, IVT may not have superiority over BMT in patients with nondisabling deficits or those using antiplatelets.
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