BACKGROUND AND PURPOSEThe safety and efficacy of tirofiban during endovascular therapy in patients undergoing intravenous thrombolysis with recombinant IV tPA remain unclear. This study aimed to ...investigate the safety and efficacy of intra-arterial tirofiban use during endovascular therapy in patients treated with IV tPA. MATERIALS AND METHODSUsing a multicenter registry, we enrolled patients with acute ischemic stroke who underwent endovascular therapy. Safety outcomes included postprocedural parenchymal hematoma type 2 and/or thick subarachnoid hemorrhage, intraventricular hemorrhage, and 3-month mortality. Efficacy outcomes included the successful reperfusion rate, postprocedural reocclusion, and good outcomes at 3 months (mRS scores of 0-2). The tirofiban effect on the outcomes was evaluated using a multivariable analysis while adjusting for potential confounders. RESULTSAmong enrolled patients, we identified 314 patients with stroke (279 and 35 patients in the no tirofiban and tirofiban groups, respectively) due to an intracranial artery occlusion who underwent endovascular therapy with intravenous thrombolysis. A multivariable analysis revealed no association of intra-arterial tirofiban with postprocedural parenchymal hematoma type and/or thick subarachnoid hemorrhage (adjusted OR, 1.07; 95% CI, 0.20-4.10; P = .918), intraventricular hemorrhage (adjusted OR, 0.43; 95% CI, 0.02-2.85; P = .467), and 3-month mortality (adjusted OR, 0.38; 95% CI, 0.04-1.87; P = .299). Intra-arterial tirofiban was not associated with good outcome (adjusted OR, 2.22; 95% CI, 0.89 -6.12; P = .099). CONCLUSIONSUsing intra-arterial tirofiban during endovascular therapy after IV tPA could be safe.
On‐treatment evaluation of patients undergoing radiation therapy (RT) and chemoradiation (CRT) is important for managing symptoms related to disease, RT, or systemic therapy. Automated extraction of ...clinical symptoms from free‐text documentation can enable the implementation of machine learning (ML) or artificial intelligence (AI) tools such as our previously developed pretreatment ML algorithm to predict ED visits and hospitalization during treatment. We present analysis of extracting on‐treatment symptom data from clinical notes via a natural language processing (NLP) pipeline.
We obtained free‐text note data for 6,918 outpatient RT or CRT courses for adult patients (for any indication) at Duke from 2013 to 2016. The Apache clinical Text Analysis Knowledge Extraction System (cTAKES) default clinical pipeline was used to extract SNOMED terms identified as explicitly present, absent, or not mentioned. These were converted to NCI Common Terminology Criteria for Adverse Events (CTCAE) v5.0 terms via the Observational Health Data Sciences and Informatics (OHDSI) Athena vocabulary. CTCAE is the current standard for oncology toxicity encoding and grading.
The performance was evaluated in 100 randomly selected notes in comparison to gold standard manual abstraction of CTCAE toxicities by two senior radiation oncology residents with adjudication by an attending radiation oncologist. Reviewers were instructed to identify all mentioned symptoms and were blinded to each other’s identifications. We created a thesaurus to harmonize overlapping CTCAE terms. Interrater reliability (IRR) was assessed based on unweighted and weighted Cohen’s kappa coefficients between reviewers and versus the consensus. Detected symptoms in notes with both positive and negative mentions were considered positive. Sensitivity and specificity were calculated on a per symptom basis.
Clinical notes for patients undergoing cancer RT.
One hundred notes representing diverse disease sites revealed disagreements between physician reviewers in symptom identification in 93 of 100 notes, with median 4 per note (range 1‐12). Unweighted kappa was 0.68 (95% CI 0.65‐0.71) and weighted kappa 0.59 (0.22‐1.00).
Based on consensus symptom identification, NLP had strong detection performance for a number of symptoms with positive mentions in notes, including radiation dermatitis (80% sensitivity, 98% specificity), fatigue (74%; 100%), and nausea 85%; 99%). Detection of pain (63%; 64%) was more limited. In contrast, negated mentions had low rates of sensitivity across symptoms, such as radiation dermatitis (19%), pain (7%), and soft tissue fibrosis 0%.
Interobserver identification of acute toxicities during cancer therapy is highly variable. Natural language processing can provide systematic identification of toxicity during therapy, particularly for positive mentions. Computational detection of negated symptoms is more challenging and represents an area for continued development.
NLP can facilitate systematic automated characterization of adverse events during cancer therapy at scale. Inclusion of symptom information from clinical notes allows for better characterization and understanding of nuances in patient symptom trajectories and without any additional burden (eg, structured data capture or workflow adjustments) by the care team. This enables real‐time opportunities for improved surveillance, quality measurement, and supportive care in clinical practice with minimal burden.
In this study, a brain-computer interface (BCI) framework for hybrid functional near-infrared spectroscopy (fNIRS) and electroencephalography (EEG) for locked-in syndrome (LIS) patients is ...investigated. Brain tasks, channel selection methods, and feature extraction and classification algorithms available in the literature are reviewed. First, we categorize various types of patients with cognitive and motor impairments to assess the suitability of BCI for each of them. The prefrontal cortex is identified as a suitable brain region for imaging. Second, the brain activity that contributes to the generation of hemodynamic signals is reviewed. Mental arithmetic and word formation tasks are found to be suitable for use with LIS patients. Third, since a specific targeted brain region is needed for BCI, methods for determining the region of interest are reviewed. The combination of a bundled-optode configuration and threshold-integrated vector phase analysis turns out to be a promising solution. Fourth, the usable fNIRS features and EEG features are reviewed. For hybrid BCI, a combination of the signal peak and mean fNIRS signals and the highest band powers of EEG signals is promising. For classification, linear discriminant analysis has been most widely used. However, further research on vector phase analysis as a classifier for multiple commands is desirable. Overall, proper brain region identification and proper selection of features will improve classification accuracy. In conclusion, five future research issues are identified, and a new BCI scheme, including brain therapy for LIS patients and using the framework of hybrid fNIRS-EEG BCI, is provided.
CoCrFeMnNi high-entropy alloy (HEA) materials were fabricated using mechanical alloying (MA) and spark plasma sintering (SPS). The MA time, SPS temperature, and contaminations strongly affected the ...final microstructure and mechanical properties. Nanocrystal face-centered cubic (FCC) solid solution was made during MA, and the FCC phase maintained as the matrix after SPS at 900 °C and 1100 °C. However, Cr carbides were transformed near the surface due to the carbon contamination. When MA time increased, phase stability of the FCC phase was improved, and the contaminant (ZrO2) from the MA balls was also increased. Ultrafine-grained microstructure was obtained at 60 min MA and 900 °C SPS. On the other hand, the higher SPS temperature and lower levels of contamination were required to achieve tensile ductility. Irregularly distributed ZrO2 particles developed bimodal microstructures.
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•CoCrFeMnNi high-entropy alloys were fabricated using powder metallurgy.•Contaminations highly affected microstructural evolution and mechanical properties.•Phase stability was improved with increasing ball milling time.•UFG microstructure was obtained under a certain condition.
Dry eye has become a common disease in ophthalmic clinics. With the continuous development and application of examination and treatment equipment, doctors' understanding of dry eye has improved as ...well as the diagnosis and treatment level of dry eye. However, there are some problems in the diagnosis and treatment of dry eye so far. Doctors rely too much on equipment to help diagnosis and ignore routine eye examinations with the ophthalmic special examinations prescribed usually being lack of definite purposes. The analysis of results is not scientific. The selection of treatment methods is not careful enough. Therefore, standardized diagnosis and reasonable treatment are the goals that dry eye clinics are required to achieve. During the clinical practice, doctors should attach importance to history taking and the analysis of clinical symptoms, strengthen the basic examination of dry eye, gradually expand the scope of examination and make a reasonable and targeted treatment plan.
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PD (Parkinson's disease) is characterized by the selective and progressive loss of DA neurons (dopaminergic neurons) in the substantia nigra. Inflammation and activation of microglia, the resident ...innate immune cell in the brain, have been strongly linked to neurodegenerative diseases, such as PD. Microglia can respond to immunological stimuli and neuronal death to produce a host of toxic factors, including cytokines and ROS (reactive oxygen species). Microglia can also become persistently activated after a single stimulus and maintain the elevated production of both cytokines and ROS, long after the instigating stimulus is gone. Current reports suggest that this chronic microglial activation may be fuelled by either dying/damaged neurons or autocrine and paracrine signals from local glial cells, such as cytokines. Here, we review proposed mechanisms responsible for chronic neuroinflammation and explain the interconnected relationship between deleterious microglial activation, DA neuron damage and neurodegenerative disease.
Aqueous rechargeable batteries are promising solutions for large‐scale energy storage. Such batteries have the merit of low cost, innate safety, and environmental friendliness. To date, most known ...aqueous ion batteries employ metal cation charge carriers. Here, we report the first “rocking‐chair” NH4‐ion battery of the full‐cell configuration by employing an ammonium Prussian white analogue, (NH4)1.47NiFe(CN)60.88, as the cathode, an organic solid, 3,4,9,10‐perylenetetracarboxylic diimide (PTCDI), as the anode, and 1.0 m aqueous (NH4)2SO4 as the electrolyte. This novel aqueous ammonium‐ion battery demonstrates encouraging electrochemical performance: an average operation voltage of ca. 1.0 V, an attractive energy density of ca. 43 Wh kg−1 based on both electrodes’ active mass, and excellent cycle life over 1000 cycles with 67 % capacity retention. Importantly, the topochemistry results of NH4+ in these electrodes point to a new paradigm of NH4+‐based energy storage.
Charging ahead: An ammonium Prussian white analogue serves as the cathode, an organic solid, 3,4,9,10‐perylenetetracarboxylic diimide (PTCDI), as the anode, and 1.0 m (NH4)2SO4 as the electrolyte in an aqueous rocking‐chair ammonium‐ion battery. The topochemistry of NH4+ in these electrodes points to a new paradigm of NH4+‐based energy storage.
Nitrous oxide (N2O) is a potent greenhouse gas and is produced in the soil by nitrification and denitrification processes. These processes are catalysed by a number of key enzymes from microbial ...communities in the soil. In grazed pasture soils, most of the N2O is emitted from nitrogen (N) returned in animal excreta deposited during outdoor grazing, particularly in the urine. The nitrification inhibitor, dicyandiamide (DCD), has been used to mitigate N2O emissions from grazed pasture soils. However, how the nitrifying and denitrifying communities and N2O emissions are affected by the urine and DCD applications under contrasting soil moisture conditions in grazed pasture soils is poorly understood. Here we report a laboratory incubation study to determine the impact of soil moisture status in combination with animal urine and DCD applications on the abundance of ammonia oxidizer (AO) and denitrifier functional genes, and N2O emissions from a grazed pasture soil. The soil used was a Horotiu silt loam (Typic Udivitrand) developed from volcanic ash. The treatments included three soil moisture contents: 60%, 100% and 130% field capacity (FC), each with Control, Urine and Urine + DCD treatments. The incubation temperature was 12 °C to simulate New Zealand autumn/winter soil temperatures (when DCD is used). Results showed that soil moisture significantly increased N2O emissions from the urine treated soil, with total N2O emissions at 100% and 130% FC being 9 and 400 times that at 60% FC, respectively. Soil moisture content also significantly affected the growth of ammonia oxidiser and denitrifier communities, with the functional genes increasing with increased soil moisture content. The application of urine significantly increased the abundance of AOB amoA, nirK and nosZ (clades I and II) genes, but decreased the abundance of AOA amoA and narG genes at 130% FC. DCD was highly effective in inhibiting the growth of AOB communities, and reducing N2O emissions at 100% and 130% FC. The abundance of nirK gene was also reduced by DCD at 130% FC, but this was, most likely, a reflection of changes in AOB populations, bearing the majority of the nirK gene detected in this study. DCD did not affect the other denitrifier genes studied. Total N2O emissions were significantly related to the abundance of AOB (R2 = 0.94, p < 0.001) and nirK genes (R2 = 0.57, p < 0.05), but not to the other genes studied. These results suggest that soil moisture has a major influence on ammonia oxidizing and denitrifying microbial communities in urine treated soils and that this affects the N2O emissions. Ammonia oxidizers are able to grow under very wet soil conditions, probably in part due to the growth of AOB communities that also carry the nirK gene.
•Soil moisture status affected the growth of ammonia oxidiser and denitrifier communities.•The application of urine significantly increased the abundance of AOB amoA, nirK and nosZ (clades I and II) genes.•Animal urine decreased the abundance of AOA amoA and narG genes.•The abundance of AOB and nirK gene was reduced by the nitrification inhibitor dicyandiamide.•N2O emissions were related to the abundance of AOB and nirK genes but not to the other genes studied.
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