Workflow and Outcomes of Endovascular Thrombectomy for In-Hospital Stroke a Systematic Review and Meta-Analysis

Background and PurposeAcute strokes due to large vessel occlusion in hospitalized patients is not uncommon. We performed a systematic review and meta-analysis to investigate the timing and outcome of endovascular thrombectomy (EVT) for in-hospital stroke.MethodsWe conducted a meta-analysis of clinical studies published in English until September 2020 in the MEDLINE and Cochrane databases. Studies reporting original data on the characteristics and outcomes of in-hospital stroke patients treated with EVT were included. We extracted data on the time-metrics from last known well (LKW) until reperfusion was achieved. We also collected data on procedural and functional outcomes.ResultsOut of 5093 retrieved studies, 8 were included (2,622 patients). The median age was 71.4 years and median NIHSS score on admission was 16. Patients were mostly admitted to the cardiology service (27.3%). The pooled time from LKW to recognition by staff was 72.9 min (95% CI: 40.7 to 105 min). 25.6% received IV tPA. The mean time from stroke recognition to arterial puncture was 134.5 min (95% CI: 94.9 to 174.1). Successful reperfusion occurred in 82.8.% with a pooled mean time from detection to reperfusion of 193.1 min (95% CI: 139.5 to 246.7). The 90-day independent functional outcome was reported in 42% of patients (95% CI 29 to 55%).ConclusionEVT can be performed safely and successfully for in-hospital strokes. Noticeable delays from LKW to detection and then to puncture are noted. This calls for better stroke pathways to identify and treat these patients.BackgroundStroke in hospitalized patients, referred to as in-hospital stroke (IHS), accounts for 2.2–17% of all strokes.¹ The majority of these are ischemic while intracranial hemorrhage represents 2–11% of all IHS.¹ These patients are expected to have a rapid diagnosis and treatment given the ongoing medical supervision, and therefore favorable outcomes.^1–3 However, existing studies report poor outcomes in patients with IHS with a mortality risk that exceeds that of community-onset stroke (COS): 24.7% vs 9.6%.⁴ Surviving IHS patients are also less likely to be discharged home compared to COS (27.7% vs 49.9%) and to be functionally independent at 3 months (31.0% vs 50.4%).^1–4     

The impact of out‐of‐pocket health expenditure on household impoverishment: Evidence from Morocco

Health financing in Morocco relies mainly on out‐of‐pocket (OoP) payments. World Health Organization (WHO) has shown that these payments can expose households to catastrophic health expenditure (hereinafter CHE) and impoverish them. The study examines the financial burden of OoP health payments on Moroccan households. Two approaches—that developed by Wagstaff and Doeslear and the one advocated by WHO—are adopted to estimate the extent of CHE. These show that 1.77% of households incurred CHE at the 40% threshold for nonfood expenditure. At the 10% threshold for total consumption expenditure, 12.8% of households incurred CHE. We find that these OoP payments have made 1.11% of Moroccan households poorer. In analyzing the determinants of CHE, we estimated an ordered probit model. It appears that any of (a) hospitalization, (b) presence of an elderly person in the household, or (c) the level of poverty increases significantly the likelihood of health expenditure becoming catastrophic. On the other hand, we find that coverage by health insurance protects against CHE.     

Novel triblock co‐polymer nanofibre system as an alternative support for embryonic stem cells growth and pluripotency

Conventionally, embryonic stem cells (ESCs) are cultured on gelatin or over a mitotically inactivated monolayer of mouse embryonic fibroblasts (MEFsi). Considering the lack of versatile, non‐animal‐derived and inexpensive materials for that purpose, we aimed to find a biomaterial able to support ESC growth in a pluripotent state that avoids the need for laborious and time‐consuming MEFsi culture in parallel with mouse ESC (mESC) culture. Undifferentiated mESCs were cultured in a new nanofibre material designed for ESC culture, which is based on the self‐assembly of a triblock co‐polymer, poly(ethyleneglycol‐β‐trimethylsilyl methacrylate‐β‐methacrylic acid), conjugated with the peptide glycine–arginine–glycine–aspartate–serine, to evaluate its potential application in ESC research. The morphology, proliferation, viability, pluripotency and differentiation potential of mESCs were assessed. Compared to conventional stem cell culture methodologies, the nanofibres promoted a higher increase in mESCs number, enhanced pluripotency and were able to support differentiation after long‐term culture. This newly developed synthetic system allows the elimination of animal‐derived matrices and provides an economic method of ESC culture, made of a complex network of nanofibres in a scale similar to native extracellular matrices, where the functional properties of the cells can be observed and manipulated. Copyright © 2013 John Wiley & Sons, Ltd.     

Une opacité pulmonaire excavée chez un diabétique

Mucormycosis or zygomycosis is a group of infections caused by filamentous fungi of the mucorales order belonging to the zygomycetes family. They generally appear in patients with uncontrolled diabetes or immunodepression, especially neutropenic immunodepression. Incidence has increased with progress in immunosuppressive therapy and chemotherapy and the absence of the use of antifungal prophylactic agents effective against mucors.We report the case of a diabetic patient presenting with an excavated opacity in the right lung which failed to improve after receiving non-specific antibiotic treatment. Direct examination of the bronchial washing specimen led to the diagnosis of pulmonary mucormycosis. Prognosis depends mainly on early diagnosis, enabling appropriate treatment with amphotericin B. Mortality remains high, around 80%; diagnosis is commonly established post-mortem.     

A Promising Energetic Polymer from Posidonia oceanica Brown Algae: Synthesis,Characterization, and Kinetic Modeling

In this study, microcrystalline cellulose nitrate (MCCN) as energetic polymer is successfully obtained from Posidonia oceanica brown algae (POBA). Fourier transform infrared spectroscopy (FTIR) results show alterations in the intensities of some absorption bands, suggesting a significant difference in the chemical structure between microcrystalline cellulose and the emergent MCCN samples. X‐ray diffraction (XRD) measurements indicate that MCCNs are more crystalline than conventional nitrocellulose (NC). According to scanning electron microscopy (SEM), both NC and MCCN reveal a compact structure and a rough surface. Differential scanning calorimetry (DSC) displays that the thermal degradation of MCCNs shifts to lower temperatures compared to the respective NCs. Furthermore, in comparison with NC samples, MCCN samples exhibit high density, high nitrogen content, low viscosity‐average molecular weight, and good thermal stability. On the other hand, kinetic modeling based on DSC data is carried out by isoconversional integral methods to determine Arrhenius parameters and the decomposition mechanisms. It is found that MCCNs present lower activation energies than conventional NCs with a decrease of ≈6%. Finally, this work opens a new pathway to prepare MCCN from POBA, and it is expected to have applications in several areas such as propellants, energetic binders, and gas generators.     

Aramid-wrapped CNT hybrid sol–gel sorbent for polycyclic aromatic hydrocarbons

This work describes the preparation of an analytical microextraction sorbent using a simple and versatile sol–gel hybrid composite, i.e., aramid oligomers wrapping multi-walled carbon nanotubes (CNTs) covalently bonded to a porous silica network. To overcome the inherent shortcomings of the CNTs'' solubility and dispersion in both organic phases and in the sol–gel solution, the outer surface of the CNTs was initially functionalized with carboxylic acid groups and then reacted with both aramid oligomers and 3-aminopropyl triethoxysilane (APTES). The obtained sorbent was characterized by FT-IR, scanning electron microscopy (SEM), and thermogravimetric analysis (TGA). Using sol–gel chemistry, the functionalized CNTs were coated onto SPME fibers and used in conjunction with GC-MS for the analysis of polycyclic aromatic hydrocarbons (PAHs) in water and soil samples. Excellent repeatability (run-to-run RSD% ∼ 8) and reproducibility (fiber-to-fiber RSD% ∼ 6) were achieved in addition to low LODs (0.10–0.30 ng mL⁻¹) and noticeable recovery%. The present method of sorbent preparation led to enhanced thermal and chemical stabilities, a long sorbent lifetime and good affinity towards PAHs. Moreover, the present sorbent enhanced the extraction capability by more than 30% compared to that of commercially available PDMS counterparts.

This work describes the preparation of an analytical microextraction sorbent using a simple and versatile sol–gel hybrid composite, i.e., aramid oligomers wrapping multi-walled carbon nanotubes (CNTs) covalently bonded to a porous silica network.     

Elevated-Temperature Tensile Properties of Low-Temperature HIP-Treated EBM-Built Ti-6Al-4V

Evaluation of the high-temperature tensile properties of Ti-6Al-4V manufactured by electron beam melting (EBM) and subjected to a low-temperature hot isostatic pressing (HIP) treatment (800 °C) was performed in this study. The high-temperature tensile properties of as-built and standard HIP-treated (920 °C) materials were studied for comparison. Metallurgical characterization of the as-built, HIP-treated materials was carried out to understand the effect of temperature on the microstructure. As the HIP treatments were performed below the β-transus temperature (995 °C for Ti-6Al-4V), no significant difference was observed in β grain width between the as-built and HIP-treated samples. The standard HIP-treated material measured about 1.4×–1.7× wider α laths than those in the modified HIP (low-temperature HIP)-treated and as-built samples. The standard HIP-treated material showed about a 10–14% lower yield strength than other tested materials. At 350 °C, the yield strength decreased to about 65% compared to the room-temperature strength for all tested specimens. An increase in ductility was observed at 150 °C compared to that at room temperature, but the values decreased between 150 and 350 °C because of the activation of different slip systems.